Is there a cure for Crohn's Disease?

[David Baxter PhD]

Is there a cure for Crohn's Disease?
by Judith Eve Lipton, M.D., Psychology Today
November 10, 2013

Crohn's Disease may be caused by a bacteria. It could be treated and prevented.

Through luck, hard work, good fortune, and perseverance, I seem to be one of the few people in the world who can claim to be ?cured? of Crohn?s Disease. I?ve told this story before, in several places, but I feel a need to get the information out to a more general audience, even though this is not a psychology story but a medical and scientific one. In September, 2005, I wrote a small article for the PCC Sound Consumer, a very small newspaper published by a local Seattle natural foods grocery store, about my experience with Crohn?s Disease.

For some reason, that little article went viral, and to this day I receive letters from people from all over the world asking for information about Crohn?s Disease and its probable connection with a specific microbe, mycobacterium avium subspecies paratuberculosis (MAP). I told the story again in a scientific journal, the Paratuberculosis Newsletter.

But that journal is not highly visible. Since 8 years has gone by, and I have much more information now, I am going to put this on Psychology Today, for the benefit of all of those who suffer from Crohn?s or who love people who suffer from Crohn?s. I will have to tell this story in several segments, since Psych Today restricts individual posts to about 800 words. Please bear with me. I will be providing a lot of information, references, and information that is crucial to individual and public health.

Single case reports are no longer the fashion in modern medicine. We all know that an n of 1 plus 1 plus 1 plus 1 ad infinitum equals nothing in terms of proving causality in ?evidence based medicine?. Proving anything in the case of Crohn?s Disease is difficult (See this excellent review of this situation, Causality and gastrointestinal infections: Koch, Hill, and Crohn?s by Anne-Marie Lowe, Cedric P Yansouni, and Marcel A Behr, Lancet Infect Dis 2008:8: 720?26). You must understand that for scientists today, a single case report is virtually meaningless. However, my victory over Crohn?s Disease doesn?t prove anything by itself, but I think that it matters insofar as it suggests the desirability of pursuing a more detailed scientific inquiry. Furthermore, there are hundreds of thousands of people with Crohn?s, many of them children, who are being treated under a different paradigm, and with variable success. Moreover, I think many of those people got sick because they consumed contaminated food products without knowing it, sometimes years before the disease manifested itself. I think there is better way to treat Crohn?s, and better yet, to prevent it. In brief, I think I was ?cured? of Crohn?s Disease with antibiotics directed at the eradication of Mycobacterium avium subspecies paratuberculosis.

Background: MAP is a very large bacteria in the same family as leprosy and tuberculosis. In 1894, two veterinarians, Dr. H.A. Johne and Dr. L. Frothingham, identified this organism in a cow with weight loss and poor milk production in Germany. It is an acid-fast bacterium, like TB and leprosy, but has other properties as well. The best place to read about MAP is on the web site @ www.johnes.org.

Farmers rapidly learned that their cows could develop either bovine TB or what came to be known as Johne?s Disease. Both were serious and expensive for the farmers. However, for various reasons, everyone agreed that tuberculosis could be transmitted from cows to people, and many public health measures were put into place to stop bovine TB. However, to this day, the USDA and the IOE, the World Organization for Animal Health, deny that MAP is a ?zoonotic disease?, a disease that can be transmitted from animals to people. The ostensible reasons for this are that MAP cannot be visualized in human tissues with ordinary microscopes (while it is easy to see MAP in animal specimens); PCR studies and other DNA fingerprinting technologies yield ambiguous results; and nobody dares to try the experiment to prove Koch?s postulates, which would be to grow human MAP in culture, and then feed those germs to human infants. That would be immoral and ridiculous. For various reasons, scientists dispute the claim that MAP causes Crohn?s Disease because Koch?s postulates have not been fulfilled, even though nobody has ever grown M. Leprae (the germ that causes leprosy) in culture. It has to be grown in the foot pads of armadillos?. Koch?s postulates are not applied to viruses, prions, or other pathogens. Even though MAP comes very close to meeting Koch?s postulates, its pathogenicity is disputed. (There was even an experiment in the 1980s in which MAP was grown from human biopsy specimens, and then fed to baby goats. The goats got Johne?s Disease. But it was a small n?)

As a result, animals that test positive for MAP are not culled and eliminated from human food products. They can be sold for meat, into the food supply. Moreover, viable MAP can be cultured from milk, including infant formulas, around the world. MAP is a very stubborn bacteria, resistant to heat and chlorine. It thrives on biofilms, and has a persistent spore that can last for years. The incidence of Crohn?s Disease in the world has grown in proportion to the use of dairy products. For example, Japan had little Crohn?s 100 years ago, and now it is becoming a significant problem. When you go to the grocery store and consider buying raw milk products, remember that MAP is endemic to cows, sheep, and goats, and roughly 1% of pasteurized milk in the US contains viable MAP.

 

[David Baxter PhD]

Is there a cure for Crohn's? Part 2

Is there a cure for Crohn's? Part 2
by Judith Eve Lipton, M.D, Psychology Today
November 10, 2013

While lying in bed, soon after discharge, I read Dr. Salah Nasser’s article in The Lancet, "Culture of Mycobacterium avium subspecies paratuberculosis from the blood of patients with Crohn’s Disease".

This article was immediately salient to me, since I knew about Johne’s Disease because I had been keeping goats.

Maybe because I was still a little agitated on prednisone, or maybe it was just good instincts, but I immediately connected the sudden onset of my severe Crohn’s with the death of my goat, and I decided to contact experts in the field of MAP to look for appropriate antibiotic treatment. (Retrospectively, I think I was wrong, I don’t believe that I caught Crohn’s Disease from the sick goat, but at the time, it seemed compelling.) I read most of the references from Dr. Naser’s article and emailed many of the scientists. I was referred to Dr. Thomas Borody in Australia for further information.

I printed a ream of papers for my own gastroenterologist and my primary care physician. The gastroenterologist did not believe a word of it, and wanted to continue with infliximab. My internist, however, was intrigued. She talked to Dr. Borody, and after reviewing the literature and discussing the situation, we decided to give Dr. Borody’s protocol a trial. Before this, blood was drawn and sent to Dr. Naser’s office for culture and PCP. The results were negative.

On December 10, 2004 my doctor started me on the Borody protocol: clarithromycin, rifabutin, clofazimine and ethambutol. I also had one more infusion of infliximab in January, 2005. I continued to take mesalamine, and tapered off prednisone, but developed secondary adrenal insufficiency requiring supplementation with hydrocortisone at physiological replacement doses (5 mg daily). I quit the ethambutol fairly quickly because of my fear of side effects. Within a month, it became impossible to obtain clofazimine in the US because Novartis, the drug company that made clofazimine, discontinued selling it in the US and donated their stock to agencies that treat leprosy, largely through the World Health Organization. However, I was able to obtain clofazimine via the US government under a “compassionate use” protocol.

I took the three medications – rifabutin, clofazimine, and clarithromycin - from December, 2004 until May of 2010. I don’t recall when I stopped the mesalamine, probably around 2007. I had no side effects. By the summer of 2005, I also had no trace of GI disease. Repeat colonoscopy in 2007 was entirely normal except for one polyp that was removed. I retained a bit of adrenal insufficiency and took small doses of hydrocortisone (5 mg or less). I never took prednisone again. In the fall of 2009 I closed my psychiatric practice and retired to a small, rural village in Costa Rica. Despite eating Third World food, for five years, including local milk, seafood and meats, as well as diverse foods sold in fiestas and tiny pulperias (corner grocery stores) I have not had a single day of abdominal cramps or diarrhea. I also no longer need or take hydrocortisone, unless I have a severe stressor. I had a repeat colonoscopy in July, 2013, and it was entirely normal, with no sign of Crohn’s. I have no systemic signs of inflammation at all: my ESR and CRP are normal and have been normal since 2005.

Dr. Borody and I have discussed the “c word”: Am I cured? I have no evidence of GI or inflammatory process, either by symptoms or regular blood tests looking for inflammatory parameters. Is it possible that receiving the antibiotics just after and even overlapping one infusion of infliximab eliminated MAP from my gut? I suppose we will never know.

Although in itself my story proves nothing, it should at least provoke serious thought among MAP researchers and especially among skeptical gastroenterologists, who overwhelmingly adhere to the traditional view that Crohn’s is primarily if not exclusively an autoimmune disease. I thank Drs. Borody, my own physician, and all of the MAP researchers for saving my life. It is highly unlikely that my recovery was unrelated to antibiotic anti-MAP therapy. In fact, I believe that the opposite is true: I strongly suspect that I had a serious MAP infection that responded beautifully to appropriate treatment. I am also aware that the idea of a Crohn’s-MAP connection is controversial, not only at the purely scientific level, but because it goes counter to current “best practices” in gastroenterology. Hospitals, drug companies, gastroenterologists and the beef and dairy industries profit greatly from the status quo, based as it is on the regnant medical “wisdom” that essentially discounts MAP as a human pathogen.

Research into the human biome has come a long way since 2005. In 2007, a study was published in Australia by Dr. Selby and others that discounted the treatment of Crohn’s with antibiotics.

That study was roundly criticized for many reasons, including poor study design. Now a more definitive study is being done by RedHillBio, an Israeli pharmaceutical company that purchased the patent to the triple antibiotic combination developed by Dr. Borody.

Red Hill hopes to enroll over 300 patients worldwide, to prove one way or the other if this therapy program works. Contact them if you wish to participate.

Nobody knows for sure at this point if MAP is a zoonotic disease. I think that it is, but many other people disagree. Nobody knows for sure if the triple antibiotic protocol for Crohn’s is better than the usual treatments with immune suppressant medications. However, common sense suggests that eating sick cows is stupid. There is no way that the UW or other countries should continue to allow cows that test positive for Johne’s disease to be used for food or milk. Its just common sense, a “yuk factor.” We should not eat meat or milk from sick animals, and we should not allow children to consume milk or meat from sick animals. The precautionary principle states that when a problem is very large, such as nuclear war or global warming, it is expedient and appropriate to take steps to prevent it, even if 100% proof of the phenomenon is lacking. It is only common sense, in keeping with the precautionary principle, to eliminate sick animals from the human food chain.

I strongly believe that if nothing else, my personal experience should encourage researchers as well as clinical physicians to question the traditional paradigm and to explore the possibility that in some cases at least, there may be an intimate connection between MAP and Crohn’s Disease.

For those who seek more information, I suggest using Google Scholar and search "MAP Crohn’s". In addition, Johne's Information Center and Dr. Borody’s web site, the Centre for Digestive Diseases, may be useful.

For those of my readers with Crohn’s, I wish you all a complete and speedy recovery and full health.