January2018

Volume3Issue2

BacteriaMayBeResponsibleforCausingMicroscopicColitis

Ever since collagenous and lymphocytic colitis were firstmedicallydescribedaboutfourdecadesago,manymedicalprofessionalshavesuspectedthatthediseaseisprobablycausedbybacterialinfections. Other types of inflammatory bowel diseases (IBD) have also beenthought to have a bacterial cause, but proof of an association hasbeenelusive.MuchresearchhasfocusedonCrohn'sdiseasebecausethe symptoms are so similar to Johne's disease in cattle, sheep,goatsandother ruminants. So far though,noconclusiveproofhasbeen found. Celiac disease is the exception to the bacterialhypothesisof IBDs,asglutensensitivity isgenerallyacceptedasitscause.

Johne's disease is caused by

Mycobacterium aviumsubspecies paratuberculosis(MAP)bacteria.Johne's is quite contagious,especially among confinedlivestocksuchasdairycattle,andit tends to infect animals whilethey are very young. Butnormally, symptoms don't startdeveloping until months or even

years later. Johne's primarily affects the small intestine, and thedamage can be extensive and debilitating among ruminants.Antibioticscanbeusedtotreatthedisease,butthereisnocure.Italwaysrelapses. Manyotherspeciesofanimalscommonlydevelopthe disease, but they usually don't appear to become sick. Onlyruminants seem to be significantly sickened by the disease.Ruminantsareanimalsthathavemultiplestomachsandchewtheircud.

So it's not surprising that researchers would suspect sometypeofMAPbacteriaor a similarpathogenas the causeofCrohn'sdisease.Butthis lineofresearchreliesonadirect linkbetweenthebacteria

and the disease, such as exists with Johne's disease. Perhapsassumingadirect link inhuman IBDhasbeenthewrongapproach.Maybebacteriadon'tdirectlycauseIBD.Maybebacteriajustcreateanenvironmentofchronicinflammationthatpredisposesahosttoacondition highly favorable for the development of IBD. Maybe asecondaryissueactuallytriggerstheIBD.

Proof that this is not only easily possible, but a likelyscenario in virtually anyone's daily life, has very recentlybeenpublished.A recently published article in the journal Science (1) verifies thedetails of how such a sequence of events might occur. This mayprove to be the elusive cause of IBD that researchers have beentryingtofindfordecades.Theresearcherswereabletodemonstratethat relatively minor food poisoning events, when repeated, couldleadtoasequenceofeventsthatresultedinthedevelopmentofIBD. Yang et al., (2017) were able to prove how this could happen byinfectingmicewithaverycommonspeciesofbacteriathatareoftenresponsible for food poisoning, Salmonella typhimurium. Theyshowed that even though the Salmonella infections they inducedwere easily resolved by the mice without a need for medicaltreatment,onlyfourrepeatedinfectionswerenecessarytocausethemicetodevelopIBD.

The researchers noted that the Salmonella induced adeficiency of intestinal alkaline phosphatase (IAP) in thehost.Various bacteria normally found in the colon produce toxiclipopolysaccharides (LPS). LPS are often referred to as endotoxins,and theyelicit strong immune responses in allmammals, includinghumans. IAP is normally produced by the small intestine and thebodyusesittoremovephosphatesfrommoleculessuchastoxicLPS,detoxifyingthemandpreventinginflammation.

Butwhenthesmallintestineisinflamed,enzymeproductioniscompromised.Whenproductionof the IAPenzyme isdiminished, thatmeans thatLPS can be only partially detoxified, resulting in a state of chroniclow-level intestinal inflammation. Production of other digestiveenzymesisimpairedaswell,andthat'soneofthereasonswhylargemeals are less likely to be digested properly when eaten by MCpatients.It'swhyeatingsmaller,morefrequentmealsmayimprovedigestion.ThissetsthestageforthedevelopmentofIBD.As similar food poisoning events are repeated over time,detoxification of LPS may become increasingly compromised. Eventually the inflammation can reach a state where thedevelopment of IBD is likely. So at themoment, the big questionfacingresearchers iswhetherornotmonitoring the IAP levelwouldbeapracticalwaytoassesstheriskofdevelopingIBD,andwhetherthe supplementation of IAPwould be beneficial, and could possiblybeusedtopreventthedevelopmentofIBD.

But why should celiac disease be exempted from thesuspicionthatitmightbecausedbybacteria,also?Celiac disease is a true inflammatory bowel disease. We all knowthat celiac disease is associated with gluten sensitivity. But whatactually initially triggers celiac disease? It appears possible (evenlikely) that the sequence of bacterial infections described abovemight trigger the inflammation that leads to the onset of celiac

disease. Gluten sensitivitymightbe the result of the inflammation(inflammation that causes increased intestinal permeability), ratherthan gluten initially causing the inflammatory process. Of course,gluten sensitivity will perpetuate the inflammation after leaky gutdevelops.Butperhapsthisexplainswhyceliacdiseasecansuddenlydevelopatarbitrarytimesandarbitraryages.

1.Yang,W.H.,Heithoff,D.M.,Aziz,P.V.,Sperandio,M.,Nizet,V.,Mahan,M.J.,&Marth,J.D.(2017). Science, 358(6370), eaao5610 Retrieved fromhttp://science.sciencemag.org/content/358/6370/eaao5610

IntroducingOurNewMicroscopicColitisFoundationBoardMember,Gabrielle(Gabes)Ryan

Gabes has 20 years of officemanager/contract/logisticsexperience in a myriad ofindustries. After years ofresearch in functional whole-body wellness, and spending 3years recovering from chronicillness, she now works asChiropractor's Assistant for afunctional chiropractic teamhelping others achieve optimalhealth.InhersparetimeGabesdoesphotographyinnatureandis keen classic car/classic racecar enthusiast. She lives inHunterValley,NSWAustralia.

OntheRoadAgain

AsWillieNelsonsings,we“justcan’twaittogetontheroadagain”. A key part of ourmotto “You can get your life back” involves thetransition from being tied to our house and bathroom to beingconfident enough to start traveling again. It is different for eachperson,buttherearesomecommonthemesandstrategiesfordoingso.Let’slookatthem,andthenhearsometravelstories.

We can feel pressure from friends and family members who arefrustrated by being limited in travel and outside activities by our

illness.Butourfirstdutyistoourselves,andweneedtoreachthepoint in our recovery where we feel confident enough that we arewillingtoexpandourhorizons.Andofcourse,ifyouhavehadabadexperiencewithasuddenneedtofindabathroominapublicplaceor have had an accident, youwill be traumatized and feel a lot ofworryandstresswhenfirstventuringout.So,astep-wiseprocesstobuildconfidencecanhelp.Herearesometoolsthathaveworkedformanypeople.

1. Keep track of your bathroom

visits,andchooseatimetobeoutwhenyouhavetheleasthistoryofneeding one. Most commonly themorningisthewhenourdigestivesystemtendstobemostactive.

2. Experiment with the strategicuse of anti-diarrhea medicationslike Imodium. Determine how

much you need, and how long it lasts, and this can provide someconfidence.

3. Plan ahead, and do a mental run of all the steps. For the firstoutings,choosesomeplaceclosewithidentifiedbathrooms.4.Preparefortheworst, justincase.Forexample,youmightwanttowearanadultdiaper,and/ortakealongatotebagwithachangeofclothesandbabywipes.

5.Graduallyincreasethelengthoftimeandthetypesofactivitiesasyougainconfidence.

6. Visit our Forum, as there is lots of advice. In the “Information”sectionoftheMainMessageBoardare“TipsonTravelingwithMC”.

The challenge is to find ways to have control of your food whiletraveling because the biggest risk is eating out. Here are somesuggestions.

Traveltoadestinationwhereyoucanrentacondothathascookingfacilities.Thengogroceryshoppingandstockuponsupplies.Ifyouareworriedaboutcross-contaminationfromthecookware,purchaseacheappanortwoandusealuminumfoilonbakingdishes.Whentravelingbyplane,planahead.Youcanpurchaseasmall,soft-sided coolerwith several compartmentsdesigned for carryingonaplane. This gives you the flexibility to bring safe food, especiallyprotein,thatneedrefrigeration.Togetthroughsecurity,atrickistoputicecubesinZiplocbaggies,emptythemoutbeforegoingthoughsecurity,andthenrefillafterwardseitherfromafoodcourtorontheplane.Oryoucanfreezesomeofthefood,whichwillthenkeepcoolformanyhours.

Travelingbycarallowsyoutopackacooler.Whenstayingathotels,theyusuallyprovideabuffetbreakfastandeven themostminimalusually have fruit and boiled eggs that can be added to what you

bring,ifthesewillworkforyou.Cell phones, GPS navigation, tablets and laptops all provide theability to search for restrooms, checkmenus at restaurants, locatespecialtyfoodstores,andmakelifemucheasierfortravel.

Cruises have advantages. If you aren’t doing well, you can easilystay in your room or close by. You can choose to take shoreexcursionsornot,dependingonhowconfidentyoufeel.Cruiseshipsare familiar with diet restrictions and usually do a good jobaccommodating your particular diet. Your traveling companion willhave company if they want to do more than you, and will haveaccesstoallthefoodofferings,soitworksforeveryone.Eatingoutcanbemadelessworrisomebyidentifyingitemsinchainrestaurantsthatwillwork,suchasahamburgerinalettucewrap,orparticular items in more enlightened restaurants like Chipotle. Investigationofmenusaheadoftimeinrestaurantswhereyouaretravelingcanprovidesomevariety.

A“ChefCard”listingwhatyoucan’tandcaneatcanbeveryhelpfulwheneatingout.Hereaacoupleoftravelstoriestoinspireyou!

GloriaWe're going on our first roadtrip since my diagnosis andI'malittlenervous.I'mnotsoconcernedabouturgentstopson the way, but more abouthow to eat away from homeforaweek.

I'llhaveafoodsuitcasewhichwill contain rice cakes, GFcereal, soup broth, potatoes,potato chips, sunflowerbutter, Ener-G egg replacer,canned chicken, pre-cookedrice, canned tomatoes, tuna,GFpasta, fruit cupsand fruitjuiceandmyrecipebox.

My cooler will containhomemade hamburger bunsand bread, mayonnaise,mustard, catsup, ghee,margarine, jelly, pre-cookedbacon, packaged chickensausage, hamburger patties,

GabesMy road trip is going prettygood, this is my first road tripholiday since MC diagnosis 8yearsago.Ihavebeeneatingout and so far so good - nomajorissueswithdigestion.The main thing I have noticedthat has changed in the last 7years is that getting 'safeingredients'and 'safemeals' isway,wayeasier. Awarenessofdietary intolerances has grownbigtime,andbeingabletoeatoutismucheasiercomparedto5-7yearsago.Menusandfood

chocolate, waffles, almondmilk in 8 oz. plasticcontainers, soda pop (formyhusband), relish, and steaksauce.Ihaveonesuitcasewhichwillcontain two electric burnerplates, a small microwaveand a toaster oven. I'mpackingdishes,storagebowlsand cooking, baking andeating utensils along withcleaningitems.Inaddition,I'velookedupthechain restaurants along theroutewhere I'vesafelyeatenwhichofferGFmenus.AGPSwould be a definite plus. Ifound awebsite that listsGFrestaurants around thecountry. It would be great totap into that while traveling.Having a laptop also helps alot because I can look uprestaurants and GF grocerystores.I am planning on preparingmyownbreakfastand lunch,but eating dinners out.Hopefullythatwillplacatemyhusband.We've only stayed at motelswhichautomaticallyprovideamicrowaveandarefrigerator.I only used the microwavetwice: once to cook broccolifor my soup and once tomake hot rice cereal. I puttwo freezer packs in thefreezerforthenextday’stripandtakeallofthefoodoutofthe coolers and put it in therefrigerator. I washed theRubbermaid drink containersand other dirty dishes in thedishpan I brought. Themotelshaveallofferedafreebreakfast formyhusband,soI didn't have to deal withbringingmyownbreakfasttoaregularrestaurant.

places are much morereceptivetodietaryrequests.Inlarger cities thanks to interestinketoeatingplans,Iwasabletogethighproteinmeals suchabreakfast thatwas justeggs,baconandavocado.Wheneatingout,Iamusinganintolerance complex productthat helps the body digestgluten and dairy to minimizeinflammation in case Iaccidently ingestthem. Ihavealso increased Vit D3 andmagnesium.As it is summer here inAustralia, I am gettingaccommodations with decentsizefridgessoIcancarrysome'safe staples’ such as coldmeats, avocado, etc. ThismeansthatIhavebeenabletostick to high protein MC safeeating plan whiletravelling.TonightweareinanAir BNB option that is a housewithfullydeckedoutkitchen.Ihave cooked steak and vegiesfordinner,andhavesomeleft-over vegies to have with mybreaky tomorrow. For $32worth of ingredients I havedone yummy dinner for twopeople (goodqualitysteakandvegies), and have ingredientsfor breakfast for two peoplewithvegies,bacon,eggs.Once home a check with myfunctional practitioner and Iwas not toxic nor ‘gutbreeched’ (functional term forno excess inflammation in thegut) I was really chuffed withthis given I was also havingtreatsofredwine.Allthehardwork,changesandsacrificesofthe first years post diagnosisaretotallyworthit!

Breakfast was easy and thesameasIateathome.Lunchwas the most difficult, asalways, primarily because Itry to rotate eatingsandwiches.Ihaven'tcookedany dinners, even though Ipacked utensils so that Icould, if necessary. Thebiggest hindrance is that aroad trip, by definition,means that you're on theroad and we were seldomchecked into a motel beforedinner.

All in all, the trip was asuccess.Iexpectedtohaveareaction here or there, and Idid.Idon'tknowifIcoulddothis for two weeks. I thinkyou'dhavetohaveanRVforanextensivetrip,ortraveltoadestination and stay there,as some have said theydo. Traveling with a specialdietisalotmoreworkthanitwasbeforeMC,butsofaritisdoable.Everytimethereisamishap,Itellmyselfthatthistrip is a learning experienceand that's why we're takingit.

AmazonSmileoffers awonderfulway tosupportthe

MicroscopicColitisFoundation.Every time you shop withAmazon through AmazonSmile, a portion of yourpurchase will be donated tothe charity of your choice atnocosttoyou.

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