Digestion, health and nutrition: Dr. Anil Minocha, a gastroenterologist and nutritionist

Good Teeth, Gums Reduce Risk of Diseases In Distant Organs

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Why is oral-dental health so important?

By A. Minocha MD, author: Guide to Alternative Medicine and the Digestive System

Oral cavity is involved in first encounter for foreign bodies and pathogens to the respiratory and gastrointestinal tract.

• Orodental space represents the tip of the spear for most things good and bad (food, drugs, toxins, pathogens) that enter the body especially the gastrointestinal tract.
• Ironically, the status of orodental cavity may reflect the overall health including nutritional and immunological status.
• Orodental changes may be cause of effect or what is happening in the body. 

Orodental flora

Oral cavity is  “dirty”. A variety of bacteria are present including pathogens that have potential for local and body-wide repercussions.

• As many as 500 species are encountered and most of them are not pathogenic.
• In the presence of immune dysfunction, the pathogenic bacteria can become pathogenic manifesting in chronic inflammatory periodontal disease and can then affect the entire body.
• Orodental activities, as simple as chewing, flossing brushing and minor procedures like  scaling result in release of bacteria into blood circulation, although the  bacteremia is usually transient.
• However, the release of bacteria or their toxic product into the circulation have potential to seed another nidus of infection/inflammation setting off a deleterious chain reaction.

 Is localized focus of infection anywhere significant

Poor oral-dental health implies a localized focus of infection.

• The word “localized” may be a misnomer since a localized focus of infection need not have localized effects only.
• Not unlike cancer, metastasis of bacterial infection may occur in the form of bacteremia, release of bacterial toxin into the circulation.
• Metastatic inflammation describes the phenomenon wherein bacterial antigen released into circulation interacts with an antibody resulting in immune complexes that can have their own disease processes. 

Localized focus of infection: A historical perspective

Concept of localized focus of infection is not new; in fact it is rooted in history of medicine since ancient times

• Hippocrates successfully treated a case of arthritis by performing tooth extraction.
• Dr. C.H. Mayo in 1914 declared in Journal of American Medical Association that “root abscesses and pus pockets connecting them are often the source of acute and  chronic rheumatism”. 

Localized orodental infection foci

• Much of  the research has focused on periodontal lesions and their systemic effects beyond oral cavity
• Caries is also increasingly attracting attention in recent times
• WHO considers caries a global health problem 

How does focus of infection including orodental affect body

Diffusion or metastasis of bacteria, toxins and antigens into the body can initiate or worsen a distant and/or generalized illness. Affects can be far away including heart and brain

• Administration of components of normal mouth bacteria (commensal) Porphyromonus gingivalis exacerbates encephalomyelitis in mice.
• An additional concept gaining traction is involvement of RAGE. 

The emerging RAGE concept (Anger at cellular level)

RAGE (Receptor for Advanced Glycation End Products ) has been implicated in multiple disorders.

• Signaling through RAGE has been implicated as a nemesis for diverse pathologies including periodontal disease, cardiovascular diseases, complications of diabetes mellitus including diabetic vasculopathy, Alzheimer disease, cancer, and neurologic conditions.
• An excess of AGEs (Advanced Glycation End Products) has been documented  in numerous organ systems including brain of patients with autism.
• RAGE are plentiful in gums and are  released into circulation when gums are inflamed.
• AGE-RAGE axis has been postulated as the mechanism of a variety of associations of orodental diseases and increased diseases beyond oral cavity including heart, blood vessels and nervous system [Katz et al 2010].

Oral-dental lesions in GI diseases

• Concept of oral-dental lesions in gastrointestinal diseases with far-reaching effects in various parts of the body  is well established.
• Examples include inflammatory bowel disease, Behcet’s disease, celiac disease etc. 

Effects of poor health on oral cavity

In addition to gastrointestinal disorders, aphthous lesions may occur due to immune dysfunction related to infections, malnutrition, allergies, stress and hematological and malignant disorders. More details in upcoming post.

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Birth control, childhood hygiene, IBD, obesity, premature death

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By A. Minocha MD, author: Guide to Alternative Medicine and the Digestive System

According to Margie Mason of the Associated Press and published in numerous newspapers, some mullahs in Afghanistan are distributing condoms while others are quoting the holy Quran to encourage longer intervals between births.

The Food and Drug Adminsteration is recalling numerous food products because of contamination with the bacteria, various parts of media is reporting. This is used in a variety of soups, sauces, chilis, stews, hot dogs, snacks, dips, and dressings. However, this contamination has not been associated with any episodes of sickness thus far. Per the report, the FDA traced this contamination to Las Vegas-based Basic Food Flavors.

A Population-based study by Klement and colleagues from Israel and published in American Journal of Gastroenterology found that childhood hygiene Is associated With the risk for inflammatory bowel disease. Lacatos states that cold chain hypothesis is providing an even broader platform by linking dietary factors and microbial agents.

Obese children have an increased increased risk of premature death from endogenous. This was reported in the New England Journal of Medicine. Other factors for premature death included  glucose intolerance and hypertension during childhood.

Multiple studies have documented  high prevalence of malnutrition and poor intake in patients who had fallen in hospital. Nutrition assessment nutritional intervention is often neglected but should be undertaken aggressively. Family members beware: Hiesmayr and colleagues report that hospitalised patients eat less food than provided as regular meal and this reduced intake inc reases risk for death in the hospital. 

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

Cola fizz, rifaximin, Crohn's, vitamin D, calcium and heart

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By A. Minocha MD, author: Guide to Alternative Medicine and the Digestive System

Coffee may be friendly to the heart. According to news reports, a study found that subjects who drank  four or more cups of coffee each day had an 18 percent lower risk of hospitalization for heart rhythm disturbances.

Cola drinks, whether flat or with fizz, should not be used for hydration in kids with acute gastroenteritis, so say Reece et al in recent Archives of Diseases in Childhood based on clinical as well as laboratory evidence. Majority of children with mild to moderate dehydration can be treated effectively with oral rehydration therapy.

Acute thermal injury from ingestion of extremely hot solid food can be seen in esophagus. The patients present with acute odynophagia. Ulceration and necrosis may be seen on endoscopic evaluation of the esophagus. This was reported by Chung etal. in Journal of Korean Medical Science.

Rifaximin therapy results in clinical improvement in patients with Crohn’s disease as reported by Shafran et al. in Digestive Diseases and Sciences. As such, it may be another option for use for induction and maintainance of remission in Crohn's disease.

Vitamin D deficiency is a growing epidemic and may contribute to multiple ailments including making people more susceptible to Crohn's disease. This was concluded by recently Wang et al as published in the Journal of Biological Chemistry.

Two systemetic reviews on effect of calcium and vitamin D supplementation on heart have been published in recent Annals of Internal Medicine. In accompanying editorial, Guallar and colleagues argue that available evidence in favor of vitamin D supplementation is far more promising than for other vitamin and mineral supplements.

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BMI, hepatitis, CAM, inflammatory bowel disease, antioxidant defense

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By A. Minocha MD, author: Guide to Alternative Medicine and the Digestive System

Systemic review of weight loss strategies for under five year old was conducted by Bond and colleagues.  Of the four randomized controlled trials, only one found a statistically significant benefit from the intervention slowing rate of increase in body mass index. Other studies did show a trend for BMI and loss in weight improvement.  

A recent study by Malgorzata Krzystek-Korpacka and colleagues documented that antioxidant defenses of red blood cells are impaired in patients with inflammatory bowel disease. 

Jain and colleagues have shown that there is increased oxidative stress and a compromised antioxidant defence system in smokers as compared to nonsmokers.

A recent cross-sectional pilot study by Erlichman and colleagues examined the use of complimentary and alternative (CAM) in 68 children with chronic viral hepatitis. Forty-six percent of these kids had used CAM at least once since diagnosis with chronic viral hepatitis and 31% used CAM monthly or more frequently. Herbals and dietary supplements were used most often.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

 

Turmeric, curcumin in ulcerative colitis

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By A. Minocha MD, author: Guide to Alternative Medicine and the Digestive System

Turmeric curry powder in inflammatory bowel disease 

Curcumin is a biologically active phytochemical component in turmeric or yellow curry powder and has been found to be effective in numerous diseases including cancer. Ulcerative colitis (one form of inflammatory bowel disease) may be one of those conditions with proven benefit.

The study below was discussed at one of the sessions at the annual Digestive Diseases week (2008) which is the largest gathering of the gastroenterologists in the world. The two panelists (Dr. Koratz from UCLA and Dr. Mullen from Johns Hopkins) gave two thumbs up to this study of turmeric and endorsed its used in ulcerative colitis.

Hanai and colleagues studied the effect of turmeric (curcumin) as a maintenance therapy for ulcerative colitis in a randomized controlled fashion. They reported their findings in the journal Clinical Gastroenterology & Hepatology in a study titled, "Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial."89 with ulcerative colitis in remisssion participated in the study. Patients received curcumin (1g twice a day) or placebo in addition to the standard treatment (sulfasalazine or mesalamine) for 6 months.

Of the patients receiving curcumin, 5% relapsed as compared to 21% in the placebo group.

The investigators concluded that curcumin seems to be a promising and safe medication for maintaining remission in ulcerative colitis. 

What are your thoughts on the above study and the action of a "natural remedy" being endorsed at a prominent medical scientific meeting? Please share your thoughts.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger. 

Organic food heals Crohn’s disease

By A. Minocha MD, author: Guide to Alternative Medicine and the Digestive System

Organic food—expensive! Should we eat this expensive organic food for better health in Crohn’s?

Study question: Would organic diet be better for healing Crohn’s?

Gasche and colleagues from Austria tested the hypothesis that organic diet is better for treating Crohn’s disease.

Patients with Crohn’s received organic diet or a control diet (low-fiber, low-fat, and high-carbohydrate). Outcome measures included MRI, endoscopy, Crohn's Disease Activity Index (CDAI), and the Inflammatory Bowel Disease Questionnaire (IBDQ).

Organic food diet showed improvement in their intestinal lesions not seen in patients assigned to a high-carbohydrate diet. The investigators concluded that food as part of the modern Western lifestyle may cause persistence of intestinal Crohn's lesions.

Diet and environmental have been linked to risk for Crohn’s disease. Diet and environment are not mutually exclusive. The increase in incidence of Crohn’s disease in recent decades suggests environmental risk factors associated with a Western lifestyle may contribute to Crohn’s disease.

What kind of diet do you prefer? Would you be willing to spend more for organic food in your diet based on this study?

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger. 

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Diet Crohn’s disease risk

By A. Minocha MD, author: Guide to Alternative Medicine and the Digestive System

Diet as risk for Crohn’s disease?

Over the years, some dietary foods predominant in vegetables and fruit have been thought of as protective. In contrast, fatty foods have been thought as increasing the risk for Crohn's disease. The literature however has been inconsistent. As such, the controversy continues as the precise cause of Crohn’s disease remains an enigma.

Dr. D’Souza and colleagues from Canada reported the results of their study in Inflammatory Bowel Diseases 2008. They examined the dietary patterns and risk for Crohn's disease in children in a case-control study fashion. Subjects included newly diagnosed Crohn’s disease compared with population and/or hospital-based controls.

Dietary patterns were assessed using a food frequency questionnaire. The study comprised of 149 cases of Crohn’s disease and 251 controls.

Girls consuming diet consisting of meats, fatty foods, and desserts had an increased risk by 4.7 fold. In contrast, boys and girls enjoying diet consisting of vegetables, fruits, olive oil, fish, grains, and nuts had a the risk decreased substantially.

The authors concluded that specific dietary patterns could be associated with higher or lower risks for Crohn’s disease in children.

Do you or someone you know has Crohn’s disease? What are your thoughts on the relationship of diet and Crohn’s disease or ulcerative colitis?

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 Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger. 

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What is colitis, diverticulitis and diverticulosis?

By A. Minocha MD, author: Guide to Alternative Medicine and the Digestive System

Colitis, diverticulitis and diverticulosis are not the same

Terms like colitis, diverticulitis, diverticulosis and irritable bowel syndrome, spastic colon can be confusing. Colitis, diverticulitis, IBS, irritable bowel syndrome, spastic colon although different are often used interchangeably by some people.

Colitis

Colitis means inflammation of the colon or large intestines. Colitis may be acute or chronic and may occur due to infections, drugs, toxins, ischemia, radiation therapy etc. Colitis may also be a manifestation of chronic IBD or idiopathic inflammatory bowel disease (ulcerative colitis and Crohn’s disease).

Diverticulosis

Diverticulosis is the presence of divertculi (plural for diverticulum), usually in the colon. The colonic divertculosis is very common in the western society presumably because of lack of fiber in diet.

As many as 50% or more may have colonic diverticulosis by the age of 50 years and this number may exceed 80% by the time one reaches the age of 80 years. Usually these diverticuli are asymptomatic and an incidental finding on barium enema or colonoscopy.

In a minority of cases, they may cause complications such as diverticulitis and gastrointestinal bleeding etc which may even become life-threatening.

Diverticulitis

Diverticulitis occurs as a result of micro-perforation in the colon at the site of diverticulum. It is usually on the left side of colon and usually contained giving rise to localized infection and inflammation. This usually responds to medical measures including antibiotics. Interventional radiology techniques are sometimes used.

At times, such a perforation may form an abscess, cause bacteremia and become even become life-threatening. Surgery may be needed in severe cases.

Diverticular bleed

Diverticular bleed occurs more commonly from right sided diverticulosis. It is usually painless and massive and usually requires hospitalization and blood transfusions.

Majority of such bleeds stop spontaneously. Endoscopic and interventional radiology techniques can help stop bleeding in some cases, otherwise they may need surgery. Recurrent cases may need suregry.

Do you or someone you know has colitis or diverticulosis? What has been your experience with these terms? Please share your thoughts.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

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 Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

DIET FOR CROHN'S DISEASE PATIENTS

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A patient with Crohn's disease (aka regional enteritis which is one part of chronic inflammatory bowel disease, the other one being ulcerative colitis) asked me, "what kind of diet should I eat and what should I avoid?". By the way, the term Crohn's diease should not be confused with irritable bowel syndrome or diverticular disease.

Diet, nutrition and Crohn's disease

The issue of diet in Crohn's disease is a tough one since there are not many good studies to help guide a recommendation. In general, it is a good idea to avoid anything that makes your gut go awry. In addition, I would suggest the following:

1. Studies  implicate diets rich in sugar, iron and aluminum in the pathogenesis of Crohn's disease. Thus, in the absence of evidence otherwise, it may be prudent to keep this in mind as we eat and drink everyday. 

• Avoid refined sugars which are abundant in sweets, candy and carbonated beverages.
• Talk to your doctor before taking iron supplements to make sure you indeed need them.
• Tea, and some herbs and leafy vegetables are high in aluminum naturally. Food processing contributes to aluminum in diet. Aluminum in diet may also come from dood additives, bakery products, powdered foods and drinks, and processed cheeses. Aluminium in food may also be derived from aluminum utensils and cans/cartons. The degree to which these contribute to aluminum in food is controversial.

In most cases of flare up of Crohn's disease, it might be prudent to eat low fiber, low lactose diet and avoid irritants like alcohol, tomatoes, spicy foods, and caffeine.

Similar dietary precautions for Crohn's disease would apply to patients with ulcerative colitis also.

Most importantly, always talk to your doctor before imposing any dietary restrictions in any sort of health condition, including Crohn's disease or ulcerative colitis.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

Proton pump inhibitors and diarrhea

Clostridium difficile-associated diarrhea usually occurs as a result of antibiotic use and can be potentially life threatening. The role of body defenses especially gastric acid secretion as a risk factor has not been fully elucidated.

Proton pump inhibitors (PPI: Nexium, Prevacid, Protonix, Prilosec, Aciphex) are frequently prescribed for acid reflux, peptic ulcers etc. They act by causing suppression of gastric acid secretion which is an important component of defense mechanism against infections.

Dr. Yearsley and colleagues studied the impact of acid blockade by chronic PPI therapy as a risk factor for development of C. difficile diarrhea and published their findings in the journal Alimentary Pharmacology Therapeutics (August 2006).

These investigators performed a case controlled study with 155 C. difficile diarrhea patients. They found that among the C. difficile-associated diarrhea group, 41% had received acid suppression with PPIs 26% of controls. This translates into the fact that chronic PPI therapy almost doubles the risk of C. difficile diarrhea.

Click to read about  How to Stop Heartburn: Simple Ways to Heal Heartburn and Acid Reflux

Take home message: Since antibiotics are the predominant cause of C. difficile associated diarrhea, the risk of concurrent therapy with PPI should be carefully weighed in patients taking antibiotics.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger