Does Cow Poop Cause IBD?

CrohnoCowPoop

Inflammatory bowel disease is caused in part by something patients are exposed to, but what exactly is still not certain. However, an IBD cluster in the town of Forest, VA provides strong evidence that a bacterium called MAP can cause IBD — and it comes from cow poop.

The Forest cluster was documented in a 2011 study published in the journal Gut Pathogens.* The cluster included 15 children — 11 with Crohn’s disease and 4 with ulcerative colitis, in a population of 8,000 people:

This represents an incidence rate of 217 cases per 100,000 children per year; more than 47 times the expected rate.

The study authors estimate as many as 45 more adults in the area might have IBD or a similar illness.

Forest is in Virginia cattle country, and the investigators quickly homed in on a culprit: Mycobacterium avium subspecies paratuberculosis (MAP). This bacteria is common in cattle, where it causes an IBD-like disease.

MAP can be transmitted from cow to cow in a number of ways, but usually through fecal contact. This can include water contaminated with cattle feces. Humans can be exposed to MAP in similar ways:

MAP is present and may be concentrated in drinking water due to the organism’s resistance to chlorination and its growth in biofilms and on metallic water pipes. We postulate that in our outbreak, individuals inhaled aerosolized MAP from contaminated water in the river or creek tributaries near their homes.

…Nine of our eleven children with Crohn’s disease were young males at the time of their diagnosis, in distinction to previous literature suggesting boys are perhaps twice more likely than girls to develop Crohn’s disease [sic]. The marked male predominance in our patients may reflect the fact that boys are more likely to play in creeks and streams than girls, but it may also be due to immunological differences between boys and girls putting boys at risk for particular infectious illnesses.

The authors and families involved contacted the Virginia Department of Health and the Centers for Disease Control and Prevention, but neither agency did any further work on the cluster. That’s unfortunate, because there is clearly more research needed.

We don’t know what causes IBD, but the Forest cluster is strong evidence that MAP can play a role.

*The study is Pierce, E.S.; Borowitz, S.M.; and Naser, S.A. “The Broad Street pump revisited: dairy farms and an ongoing outbreak of inflammatory bowel disease in Forest, VA.” Gut Pathogens 3:20 (2011).

Photo “cow’s arse” by Flickr user rhys000 used under Creative Commons license.

Have Bag, Will Travel

CrohnoLaura

(This is a guest post by Laura. She lives in Australia and blogs at Stomalicious; you can follow her blog on Facebook.)

I’m a traveller. Ever since I was little, my parents took me on overseas holidays, and as a teenager I caught the “travel bug”. I was blessed with many amazing trips to exotic, faraway places. If I didn’t go overseas at least once a year, I would get itchy feet!

Then I turned 30, and I got a different kind of bug. This one was called IBD. It was way more than just a bug. Medications, diets, nothing seemed to work for me. My symptoms, side effects, and anxiety worsened. My joys of overseas travel — and dream of living and working overseas — came to an abrupt halt.

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Test Your IBD Savvy

CrohnoSavvyA recent study reports that patients with inflammatory bowel disease have poor knowledge of their illness. Do you do any better? Our quiz is adapted from the same test used in the study.

The study was was headlined, “IBD patients have poor disease related knowledge regardless of education level“, but it was conducted in Chile and so might not apply to patients everywhere. The study used a test called the Crohn’s & Colitis Knowledge questionnaire (CCKNOW). While a score of 9 out of 20 was typical in this study, other countries report median scores from 4 to 13. More knowledge of the disease has benefits for self-care, but is also associated with higher anxiety.

The quiz below is adapted from the CCKNOW; the full questionnaire has 30 questions, but this quiz only has ten. I am grateful to Dr. Jayne Eaden, the lead author of the CCKNOW, for providing the correct answers.

Click ‘more’ to take the quiz…

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“I do not want to live like this anymore.”

CrohnoHids

(Harm Hids is a Crohnology member from the Netherlands.)

During vacation in summer 2014, my son told me, “I do not want to live like this anymore.” To hear this from your 16-year-old son is heartbreaking.

Three years earlier, he was diagnosed with Crohn’s disease. He had many, many flares. He was depressed, following a very restrictive diet, and not drinking enough fluids. At the time, he was taking Imuran and steroids.

I asked him what he wanted to do, and he suggested cannabis. He found many success stories online, and we live in (Amsterdam?), where cannabis is legal. Neither my son nor I take (or took) any drugs for recreational use.

Researching online, I found the Crohnology community, where medical cannabis is listed as very effective — in fact, more effective than prescription medications. It seemed we were on the right track, but we also learned that ‘medical cannabis’ is a family name for endless varieties and many ways of administering. We quickly dropped the idea of smoking or vaping; oil is a better way to dose.

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“I Couldn’t Breathe From The Pain…”

CrohnoRodaina

(Rodaina is a Crohnology member from Jordan.)

I first had symptoms in 2000. In the 8 next years I suffered from stomach & colon pain, sometimes constipation and sometimes diarrhea, off and on. I thought it was normal since some members in my family have colon problems.

Then… 2009 was the worst year in my life. I had more pain in my colon, stomach & joints. I had horrible diarrhea and I started to lose weight. I barely could eat. Red swelling appeared on my left ankle, and I had fever, fatigue, vomiting, etc.

I saw many doctors and they had many opinions. They said I may have celiac disease, thyroid problems, even gout! But all the tests showed they were wrong.

In the meantime, my condition became worse than ever. Eating was painful enough that I decided not to eat anymore. The red swelling spread to all of my left leg and became purple/blue, then black. I couldn’t breathe from the pain in my colon and foot. Another red tumor appeared on my right foot. I felt crazy because I still didn’t know what my disease was.

I entered the hospital in June 2009. After all kinds of tests, the surgeon said that I have “necrotizing fasciitis”. After three surgeries and tons of medicines, my right foot was healed and the left one saved from amputation by a skin graft. It was a miracle to be able to walk again.

After my discharge in August 2009, our neighbor — who is an anesthetist at a local hospital — advised me to see an internist at the same hospital. “Maybe he will know what you are suffering from,” he said.

I went to see that doctor and after hearing my history, he requested immediately a colonoscopy, endoscopy, x-rays & CT scan. It worked. Finally I knew the reason for my illness during the past 9 years: the doctor sent a biopsy to be tested, and the results showed that I have Crohn’s Disease.

My healing process started by taking the right medicines, making the needed tests every month to avoid any unwanted side effects and having regular appointments with my internist to follow up my condition.

Having Crohn’s means that you need to learn how to live with it. If you don’t, then you’re going to suffer and fight every day without having a chance to beat it.

You can only beat Crohn’s by living with it, so I learned to live with Crohn’s. Following up with my internist, committing to my diet, and following my drawing passion… these three elements what help me to face the difficulty of having Crohn’s.

Crohn’s doesn’t affect my daily work anymore. I’m a full time worker — a hard worker, just like a normal person. I can say that I’m a healthy person now.

(If you would like to guest post for Crohnology, please see our guidelines.)

Abandon Hope… To Be Happy?

CrohnoHopeWhen illness blocks your way in life, how do you respond? Do you keep pursuing your goals, hoping that you can overcome that obstacle? Or do you accept your situation, and find other things to aim for? A study claims that to be happy, you have to give up hope.

People with inflammatory bowel disease often need surgery, and in some cases that will mean a colectomy – the removal of the colon. In some cases, that operation can be reversed — making the ostomy temporary. In some cases, the operation is permanent.

In 2009, team of economists published a study titled “Happily Hopeless”, reporting that people with permanent colostomies were ‘happier’ than people with temporary ostomies. The study got a lot of press, with reports claiming it shows that sick people who give up hope are more happy.

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Are Pain Meds Bad?

CrohnoPainPain is common among people with IBD. For many of us, it is the most debilitating symptom. Yet we are often told that pain medications will make us worse. Are pain meds really that bad?

By “pain meds”, I mean opiates and opioids: sometimes called ‘narcotic pain killers’. Opiates are natural chemicals from the poppy plant — the same plant that produces poppy seeds. Some popular prescription opiates include codeine and morphine.

Opioids are similar drugs made by synthetic means. Some popular prescription opioids include oxycodone (in Oxycontin and Percoset) and hydromorphone (in Dilaudid). Heroin is also a very popular opioid, but it is illegal most places.

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Are You Bullied At Work?

CrohnoBully

People with IBD sometimes have problems with the demands of full-time work. Whether it’s fatigue or pain or bathroom breaks, an ordinary work day can be very difficult. According to a recent study, there is yet another way work can be stressful: workplace bullying.

The study, published in BioMed Research International, looked at 700 patients (all in Italy). Of these, 397 had inflammatory bowel disease. The other diseases included autoimmune arthritis and psoriasis. To define the problem, the study authors provided subjects with following definition:

bullying takes place when one or more persons systematically and over time feel that they have been subjected to negative treatment on the part of one or more persons, in a situation in which the person(s) exposed to the treatment have difficulty in defending themselves against them. It is not bullying when two equally strong opponents are in conflict with each other

Subjects completed a survey that asked various questions about their health, and about workplace bullying.

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Which Natural Therapies Work?

CrohnoNaturalMany people with inflammatory bowel disease turn to ‘natural therapies’ — sometimes called ‘alternative medicine’ — to manage their symptoms. Are any of these therapies proven effective?

To find out, the Australian government reviewed 17 different therapies, including yoga, homeopathy, reflexology, and Tai Chi. Their goal was to determine which therapies should be eligible for government insurance rebates. The review looked at the medical literature for evidence supporting each therapy, especially randomized controlled trials (RCTs).

The report of the review process is available online. For the most part, the reports says, “there was not reliable, high-quality evidence available to allow assessment of the clinical effectiveness of any of the natural therapies for any health conditions.” There just wasn’t enough information to prove the effect of most therapies.

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Which Over-The-Counter Meds Help?

CrohnoOTC

People with IBD often take over-the-counter (OTC) medicines and supplements in addition to their prescriptions. While there is lots of research on prescription drugs, it is hard to find reliable information on OTC products.

Crohnology members, of course, have access to our treatment database. There you can find information and rankings for many popular supplements. Vitamin B12, Probiotics, Iron, Vitamin D, and digestive enzymes are all highly rated (although B12 may include people who receive injections).

In decades of dealing with the disease, I have tried dozens of OTC products, mostly with no success. A few, however, stand out as being truly helpful. These are not official endorsements, but just a partial list of medicines I have found effective:

  • Bean-O: this supplement is basically a digestive enzyme, but it totally changed my relationship to vegetables. Bean-O works by breaking down the plant matter that causes gas for most people. For me, that plant matter causes cramping and diarrhea. Taking Bean-O has helped me rediscover salads and other raw veggies that were missing from my diet. I started small and built my way up to full servings, but now I have no problem digesting veggies if I take Bean-O before.
  • Loperamide: this is the active ingredient in Immodium, the anti-diarrhea medicine. I take four every evening, to keep my guts quiet through the night. I know this causes cramping for some people — it used to, for me — so this is definitely one to talk to your doctor about.
  • Melatonin: I also take melatonin every night to help me sleep. Melatonin is a hormone your body is supposed to make naturally to regulate your sleep cycle. I take it an hour before bedtime, and it helps me fall asleep.
  • Diphenhydramine: this is the active ingredient in Benadryl and Unisom, and is often used by IV for hospital patients having trouble getting enough sleep. I don’t take it all the time, but it is a real help if melatonin isn’t enough to get me to sleep. Usually half a Unisom quick-melt lozenge is enough to help me sleep without being groggy the next day.
  • Pectin lozenges (Luden’s): most cough drops and sore throat lozenges have ingredients that mess up my guts. Pectin lozenges help — not as much as medicated drops, but enough that it’s worth having them.

It is a good idea to talk to your doctor about any OTC medicine you want to try specifically for IBD, and definitely remember to list all meds — OTC and Rx — among your current medications when filling out forms.

What OTC meds and supplements have worked for you?