Clinical Management of Crohn's Disease
Crohn's and Excessive Immune Stimulation
At its core, Crohn's Disease is a chronic immunological disorder than results in a patient's immune system to be running at high levels all the time. The treatments given to patients with Crohn's Disease are often only directed at minimizing the impact of this excessive immune response at the mucosal surface of the intestinal tract or within a fistula.
This excessive immune stimulation is similar to a car sitting still but having its engine running at excessively high RPMs (revolutions per minute). There is a high amount of physical stress caused by this excessive immune stimulation, and often much of it results in a deficiency of glutamine.
In this way, the physical stress associated with Crohn's Disease is similar to what I have discovered to occur in HIV Disease. The chronic immune activation results in excessive consumption of glutamine (a critically importance amino acid in stressed or ill individuals) by the immune system thereby robbing other vitals bodily systems of their share of the body's available pool of glutamine. (see handout for glutamine in HIV Disease)
As the diagram above depicts, excessive immune activation will result in a depletion of the body's available glutamine. Some research suggests that glutamine is preferentially burned as a fuel source by cells of the immune system when they are activated.
The body will begin burn precious muscle which is the body's primary storage site of glutamine in order to try to fuel the persistent immune response and other glutamine-dependent physiological functions such as maintenance of normal intestinal absorption and the production of glutathione.
Weakness and Muscle Mass Depletion
As mentioned above, persistent immune stimulation leads to an excessive demand for glutamine by the immune system. The body will begin burn precious muscle which is the body's primary storage site of glutamine in order to try to fuel the persistent immune response and other glutamine-dependent physiological functions such as maintenance of normal intestinal absorption and the production of glutathione.
This process of burning muscle to obtain the glutamine contained within is known as catabolism and can result in a significant loss of muscle mass. The loss of muscle often causes patients to become weak and have a loss of stamina that is most no tic able after a day at work or a busy week. Patients will often complain they barely have enough energy to get through the workday yet alone all the other things that need tending to when they get off work (grocery shopping, cleaning, cooking, yard work etc).
Supplementation with glutamine brings about marked improvement of muscle mass with an associated improvement in energy, stamina and overall well-being. Patients often report that the joints in their hands, wrist or feet also feel better. Whether this is due to improvement in muscle mass surrounding the joint or possibly some other unknown benefit of glutamine is not known.
Diarrhea in Crohn's Disease as Many Causes
The lack of glutamine also has an impact on the pattern and amount of diarrhea a patient with Crohn's Disease may experience. Glutamine is a required fuel source by the cells that line the small intestine and assist in the absorption of nutrients. Without glutamine, cells will sink in size ( a process known as atrophy) and be unable to properly absorb the nutrients in our food, leading to a condition known as malabsorption.
Malabsorption causes diarrhea that most often occurs after eating. Patients will often report of having to go to the bathroom either during a meal or within an hour or so after their meal. This component of their loose stool history is often thought to be primarily associated with the underlying Crohn's and not with glutamine deficiency.
Supplementation with oral glutamine results in significant improvement of post-meal diarrhea within about a 7-10 days.
Patients with any residual post-meal diarrhea after treatment with glutamine often simply have bacterial overgrowth which will resolve with some metronidazole therapy and/ or supplementation with a probiotic such as Culturelle.
Low dose Naltrexone and Crohn's Disease
There is some recent research demonstrating that low dose naltrexone may induce remission in over 50% of patients treated. I have tired it in several patients of whom all clearly benefited and of whom none had any noticeable side effects.