flaredupfitness- Health, Nutrition and Fitness with Crohn's Disease
My name is Troy Parsons. I was diagnosed with Crohn’s Disease in 2009 at the age of 17. This blog is a look into what I deal with on a daily basis. This blog is to share my story while promoting health, wellness, nutrition, and fitness. I want to show people with my disease what can be possible while pushing the limits of their body and mind even with a debilitating chronic disease.
Looking back, it’s been just over 4 years since I started FlaredupFitness.
To be honest, I haven’t been blogging much. There’s nothing I love more than waking up early on a Saturday morning, caffeine buzzed and pounding away on my keyboard as the sun comes up. I find blogging therapeutic. It gets all the chaotic randomness constantly going through my head organized onto a page (hopefully) in a clear and concise manner.
I started blogging for a reason and I often forget why I do
it. I write these blogs because I genuinely want to help others in a similar
situation as mine. I know what it’s like to feel alone and secluded with no
idea where to start.
I was diagnosed with Crohn’s Disease in 2009 at the age of 17; a disease I had never heard of before. With little information online, I struggled to find the answers I was looking for. Doctors were not a lot of help, they just couldn’t relate without going through it for themselves. Living in a small town, isolated from large urban centers, I personally did not know anyone that had IBD or anyone that could relate to what I was going through. I couldn’t find the resources online that I was searching so desperately for. I had to figure out for myself through trial and error and what worked specifically for me. I started FlaredupFitness to share my story and hope that it can help someone avoid the mistakes I made along the way.
Connecting with others from all over the world has been the most motivational and inspiring part of starting FlaredupFitness for me. I had no idea that hearing others struggles, successes and failures that are undeniably relatable to mine creates an instant connection that I can’t find anywhere else. Knowing there are others out there doing amazing things despite their disease keeps me going and gives me hope.
What I’ve learned living with Crohn’s
Going through the process of living with an incurable disease is certainly an invaluable learning experience and I am glad I went through it despite my suffering and setbacks. I am inevitably stronger and more capable than I ever was before Crohn’s. I know I can overcome and persevere through whatever life throws at me. I took what I learned along the way and used that passion and burning desire to succeed to apply it to all other areas of my life. Something I do not know if I would have found inside myself without the suffering and adversity that comes along with a chronic, incurable disease.
Taking a look at where I’ve come from and being inspired by
where I’m going, always puts a smile on my face. My experience with Crohn’s has
opened my mind and taught me so much about myself that you can only learn through
adversity. I know what it’s like to hit rock bottom and it eliminated the fear
of unknown for me. I know I can dig deep and pull myself out of whatever unfortunate
situation I’m faced with when times get tough.
Through the adversity, Crohn’s has instilled a mental tenacity and toughness far beyond what I thought I could make it through. Through my experience, I learned that I am always more resilient than I ever imagined, and I would have never known it until I was backed into a corner, fighting for me health.
Although I have a hard time slowing down, sometimes taking my foot off the gas and regrouping is just what I need to bring everything full circle. I often find myself asking “why am I doing this?”
Remembering why I started comes down to the pure passion and purpose of feeling like this is exactly what I’m meant to be doing. It brings everything back into perspective again.
Whenever you feel lost or unmotivated, remember why you started.
Thanks to everyone for a life changing 4 years of
FlaredupFitness! I’ve learned and experienced so much in the last 4 years and
can’t even imagine how much further along I’ll be in another 4.
If you haven’t yet, download the Oshi Health app to see all my latest blog posts! Any topics you want me to tackle in an upcoming blog post, comment below.
I haven’t done one of these for a while. It’s been just over a year since my second surgery and it’s crazy to think how far I’ve come.
If you’ve been following along on some of my previous blog posts, my symptoms progressively got worse through 2017 and became so severe that I was unable to work or function day-to-day. Suffering through every day with chronic pain is not something I would wish on anyone. It sucked the enjoyment out of life for me and that’s no way to live.
Sadly for those with IBD, surgery is often an inevitable part of the disease. Unresponsive to a medicative approach and out of options, one severely strictured segment of my small intestine was surgically removed in October 2017. Following my surgery, I prematurely jumped right back into my chaotic lifestyle continuing my career as a Geoscientist.
To read about how my surgery went, I linked all my related blog posts in the footnotes below.
When I’m healthy and feeling good, I’m driven and focused on my career, fitness and personal goals. I do my absolute best to make the most out of the time I feel healthy, and I’ve been feeling great for the most part.
But in the past two weeks, I’ve had a sobering wake-up call with the return of severe abdominal cramping. An all too familiar reminder that gives me painful flashbacks to a time not so long ago, where I was left crippled and debilitated by my disease.
Constant aching pain, fatigue and severe abdominal cramping is a typical indication of a flare-up for me.
My Greatest Strength is also my Biggest Weakness
I put a lot of pressure, demand and stress on myself in anything I do; that’s just part of my personality. How I do one thing is how I do everything, and I have a very hard time letting up on the gas pedal when my health deteriorates. Knowing I’m mentally strong enough to push through but limited by my body and forced to step back because of my disease, is crushing and demeaning. It’s the hardest part of living with Crohn’s Disease for me. I have the mental strength and fortitude to deal with the setbacks, but I find it incredibly difficult to slow down.
Often your greatest strength is also your biggest weakness.
It’s a trade-off. Any situation that creates stress and forces me to step my game up is where I typically thrive. When I have to push myself out of my comfort zone or do something beyond my capabilities is where I’ve found I do my best work.
I often find myself seeking out these situations because I am never satisfied or happy with a place of complacency. This unhealthy obsession usually works well for me and forces growth but also at a cost to my health.
I know I preach about stress and listening to your body but sometimes it’s a lot easier said than done. It’s one of my biggest faults that I will always be working on.
How I manage a Flare-up
For now, my current protocol when symptoms arise is listed below:
Scale back on the intensity, load and frequency of training. I still exercise depending on the severity of the flare-up.
Alter my diet to accommodate softer, more easily digestible foods. Eggs, salmon, avocado, coconut oil, oats, bananas, chicken/turkey breast, white rice, peeled and baked sweet potato, smoothies, collagen protein etc.
Lower insoluble fibre consumption and eliminate most vegetables, peel all fruit and eliminate anything that could get stuck in the presence of inflammation causing an obstruction. I often drink smoothies to get additional nutrients in unless I am having frequent bowel movements.
Implement stress management techniques such as meditation, walking in nature, spending time to myself.
Fast! There are tremendous benefits to fasting including reduced inflammation. I fast multiple times per week but when flaring I implement prolonged fasts >24hr. I wrote a guide on fasting that I’ll link it at the bottom of the page.
Limiting or eliminating caffeine and eliminating all alcohol (I don’t usually drink much to begin with)
Keeping nutrition dialed and supplement accordingly. Glutamine (can help reduce intestinal permeability), CBD oil, turmeric (with black pepper for increased bioavailability) and ginger for anti-inflammatory properties, coconut oil, bone broth and or collagen protein are staples I use frequently, not just during a flare.
Sleep: I prioritize sleep when I’m healthy but when I’m in a flare-up, I sleep as much as possible. I prioritize sleep over all other things even if it means canceling plans, being antisocial or missing a workout. This is non-negotiable.
Being in-tune and listening to my body. Again, this is something I’ve learned through experience but I will always be working on.
*Disclaimer*: This is just simply what I do and what seems to work for me. This is not medical advice or what will work for you. IBD is a very individual disease and what works for someone may not necessarily work for you.
I am hoping I can get control of my symptoms without the need for additional medications such as prednisone. As much as I despise prednisone, it works incredibly well and is sometimes a necessary evil. I know many of you can relate.
Until next time, head over to the Oshi Health app to read other awesome blog posts from myself, Medical Professionals, GI’s and many other Patient Advocates! Oshi is available for free on the Apple and Android app store.
Since being diagnosed with Crohn’s Disease in 2009, my life has drastically changed. A sobering wake up call at 17 years old when I had to come to terms with a diagnosis of an incurable, chronic disease that I had never heard of before.
I refused to admit I had a debilitating condition. I tried my best to move forward and ignore my severe symptoms like nothing was wrong. I wanted nothing more than to be considered “normal” like all my friends. I heard about others with illnesses, but it never crossed my mind that it was going to happen to me. I no longer felt young and invincible but rather weak and vulnerable.
My health continued to deteriorate as I pushed through rock bottom trying to figure out how to get my quality of life back. Exhausted, defeated and unsure if I will ever be able to recover, the unknown is the most terrifying part. I was at my lowest point.
After years of refusing to acknowledge my disease, I finally recognized that I wasn’t like everyone else and having a chronic disease made me unique. Knowing how far I’ve come, what it’s like to hit rock bottom and battling my way back to a better version of myself than I was before Crohn’s is what keeps me moving forward. Consistently pushing myself beyond what I thought I was capable of is invigorating for me.
A blessing and a curse, battling Crohn’s Disease has forced me to appreciate every day I do feel good and not take my health for granted. It feels like I’ve found my purpose. Allowing me to share my story and connect with so many others on their own personal journey motivates and inspires me to continue fighting.
Just the experience of living with Crohn’s has felt like I’ve learned a lifetime of knowledge in just 10 years. It has forced me to take a hold of my life and change my perspective on everything. Food, nutrition, lifestyle and exercise has never been more important to me. Just feeling good has made me immensely more appreciative and gives me motivation to get my health back when I am sick.
My journey is far from over but I’m going to keep feeding my appetite for knowledge and continue working towards complete optimization of my physical and mental health.
When life sucks, smile. There is always something to grateful for.
Taking a step back, I find it incredible to see how much I’ve grown since being diagnosed with Crohn’s Disease in 2009. I’ve gone through the successes, failures and countless adversities caused by my disease. I am thrilled to have a platform that allows me to share my story and connect with so many amazing others also on their own journeys. I can hardly believe all the opportunities that have come along by just sharing my story.
Starting FlaredupFitness is the most rewarding thing I’ve ever done. It feels like I now have a purpose and I attribute many of my greatest strengths to what I’ve learned battling Crohn’s Disease.
I’ve taken a step back from my blog the last few months to collaborate on another project. I’ve been hard at work blogging for a new IBD focused app called Oshi Health. It is my pleasure to share Oshi with everyone. I am so excited see what the future brings by blending the latest technology with health.
I am always hesitant and very picky about what products or companies I promote and support.
Staying true to FlaredupFitness, I owe it to everyone following my blog that I am completely transparent and honest with any products that I am advocating or supporting. I would never share something that I wouldn’t use or believe in myself. Oshi has spared no expense and gone about business the right way.
I believe for an IBD app to be successful they need the IBD community’s support and guidance. Oshi did just that. They have a genuine approach taking guidance from IBD patients (including myself) and listening to their requests and suggestions. As well as consulting with various health professionals and offering Q&A style questions answered by Physicians and GI’s.
As you already know, I am adamant about tracking. I love looking at the numbers, tracking trends, seeing results and correlating why I might be feeling a specific way. Oshi Health allows you to track everything within an app to help manage your health and overall well-being. It simplifies and streamlines exactly what I’ve been doing subconsciously for over 9 years. I just wish I had something like this when I was first diagnosed, it would have made the transition much more seamless.
Oshi: The First All-in-One App for IBD Management - YouTube
Flared Up Fitness - Cinematic Workout | Sony a6300 + Zhiyun crane V2 - YouTube
Turning setbacks into comebacks after getting a section of my small intestine removed in October. If you look closely, the scar below my belly button constantly reminds me of the adversity I’ve faced and the struggles I’ve had to overcome. Always reminding me to never take my health for granted.
Deep into the offseason and only 5 days to prep for this shoot, more edits coming soon when I tighten things up!
Thanks to LJL Films for this sick edit, big things coming from this guy soon!
These evidence-based botanical medicines proven to induce or maintain remission in the debilitating inflammatory bowel disease known as Crohn’s offer hope to those resigned to a fate of life-altering immunosuppressive drugs or surgery.
Inflammatory bowel disease (IBD), which is subdivided into ulcerative colitis and Crohn’s disease, afflicts 1.4 million Americans and typically first appears between the ages of 15 and 30 (1). Whereas ulcerative colitis is more distal, affecting the rectum and spreading upwards toward the descending and transverse colon in an uninterrupted fashion, Crohn’s disease typically involves the ileum and colon and can affect any part of the digestive tract, often in a discontinuous pattern characterized by skip lesions (2).
In ulcerative colitis, inflammation is generally circumscribed to the mucosa, whereas inflammation can navigate down intestinal crypts, becoming transmural or penetrating the entire depth of the intestinal wall in Crohn’s disease (2). Due to this disparity, Crohn’s disease can ulcerate through the layers of the bowel into the mesentery, leading to complications such fibrosis or scarring of tissue that leads to strictures or perforations, as well as intestinal granulomas and fistulas (2). Fever, diarrhea, abdominal pain, rectal bleeding, and weight loss are hallmark symptoms.
Although risk is multifactorial, there is a prominent genetic predisposition, with first-degree relatives having a 12 to 15 times elevated risk of developing Crohn’s disease (3). Cesarean section delivery, smoking, early life antibiotic use, low fiber intake, and use of oral contraceptives and non-steroidal anti-inflammatory drugs (NSAIDS) are all correlated with risk of Crohn’s disease (4, 5, 6, 7, 8). Ultraviolet sun exposure is protective, as exhibited by marked a latitudinal gradient for IBD-related hospitalizations whereby northern states have significantly more admissions (9, 10).
Not only is microbial dysbiosis fundamental to IBD, but “Accumulating evidence suggests that inflammatory bowel disease results from an inappropriate inflammatory response to intestinal microbes in a genetically susceptible host” (2, p. 2006). Viruses from the herpes family, including Epstein Barr Virus (EBV), cytomegalovirus (CMV), and human herpes virus 6 (HHV) likewise occur at a higher prevalence in IBD and may play a role in its pathogenesis (11).
Crohn’s and colitis have different clinical features, but both exhibit a relapsing and remitting course, and both represent autoimmune pathologies of the gut. Because the disease etiology is autoimmune in nature, people with IBD are at increased risk for other autoimmune disorders including psoriasis, ankylosing spondylitis, and primary sclerosing cholangitis (12). Although standards of care, such as corticosteroids, antibiotics, biologics, and immunosuppressive pharmaceutical drugs are fraught with life-threatening side effects, there are evidence-based natural substances that can be used as adjunctive therapies alongside a holistic regimen that includes an anti-inflammatory diet, stress management, social support, physical activity, and sleep hygiene. This review will emphasize selected therapies with empirical evidence in Crohn’s disease, with a focus on human trials.
Although glutamine is not an herb, its prolific evidence-base renders it worthy of inclusion. In Crohn’s disease, the main objective of treatment is healing the mucosal lining of the gut, which is associated with reduced disease activity, elongated duration of remission, and decreased requirement for surgical resection of the bowel (13). Reversing the pathologic paracellular intestinal permeability, colloquially known as leaky gut syndrome, will not only arrest Crohn’s disease processes, but it will also mitigate risk of future autoimmune diagnoses since gut barrier integrity precludes the ability of immunogenic material and foreign antigens to translocate into systemic circulation and incite self-directed autoimmune responses (14).
According to researchers, “Glutamine is presently the best known compound for reducing intestinal permeability (IP)” (15). Glutamine is considered a conditionally essential amino acid in the critically ill, meaning that, during periods of severe metabolic stress, the ability to synthesize sufficient quantities of glutamine is exceeded by the body’s requirements for glutamine (16). Glutamine speeds healing of damaged enterocytes (intestinal cells) and improves mucosal barrier integrity, as it is the preferred respiratory fuel over glucose for rapidly dividing cells (17). Not only does it enhance the rate of cellular renewal or turnover, but it also prevents cell death, or apoptosis, associated with cellular stress (17).
Glutamine has been shown to reduce infection frequency following abdominal surgery, shorten hospital stay, enhance long-term survival, and improve intestinal barrier function in malnourished children, critically ill patients with multi-trauma or multi-organ failure, premature neonates, disorders of ischemia/reperfusion, bone marrow transplantation, and experimental biliary obstruction (18, 19, 20, 21, 22, 23). Moreover, glutamine supplementation protects the gut during recovery from high-intensity exercise, which has been demonstrated to induce transient leaky gut (24).
Glutamine likewise maintains transepithelial resistance, or the electrical voltage across epithelial cell barriers required for proper cell communication, and reduces permeability in cell culture in vitro studies of intestinal cells (25). In a randomized clinical trial of Crohn’s subjects in remission, L-glutamine administered at 0.5 grams per kilogram of ideal body weight per day for two months normalized intestinal permeability in 57% of subjects, and also significantly improved the intestinal villous-crypt ratio, a marker of intestinal architecture which is blunted in Crohn’s (26).
An evergreen shrub native to the Mediterranean called Pistacia lentiscus var. Chia (Anacardiaceae), also known as Chios mastic gum, has been revered for its therapeutic effects in the liver, stomach, and intestines since ancient Greek and Roman times (27). Oleanolic acid, a triterpene within mastic gum, exerts anti-inflammatory and anti-cancer effects and prevents chemical-induced hepatotoxicity in animal models (28). Mastic gum additionally possesses antiatherogenic, antioxidant, antibacterial, and anti-ulcer effects (29, 30, 31).
In a four week pilot study of patients with mild to moderately active Crohn’s disease, patients received six capsules a day of mastic gum, with each capsule containing 0.37 grams (27). Compared to baseline, Crohn’s Disease Activity Index (CDAI) was significantly decreased post-treatment alongside significant increases in total antioxidant potential (TAP), presumably due to the triterpene and phenolic compounds contained in mastic gum (29). Increases in TAP result in improved capacity to neutralize the oxidative stress and inflammation that promote Crohn’s disease pathogenesis (27).
Likewise, post-treatment, patients exhibited significant decreases in interleukin-6 (IL-6), a pro-inflammatory intercellular signaling molecule that recruits other immune cells, and plays “a pivotal role in induction and amplification of the inflammatory cascade” (27, p. 748). IL-6 similarly incites production of inflammatory acute phase reactants from the liver, and promotes differentiation and proliferation of T cells and B cells, lymphocytes which perpetuate the disease process (32, 33).
C-reactive protein (CRP), an acute phase reactant that is a surrogate marker for systemic inflammation, was also significantly decreased after mastic gum treatment (27). A trend towards decreases in monocyte chemotactic protein 1 (MCP-1), a chemical messenger which incites macrophages, a subset of immune cells, to migrate to the site of inflammation and infiltrate tissue, was also observed in Crohn’s patients after the trial (27, 34). Lastly, there was a pattern towards improvement in the Nutritional Risk Index (NRI) in Crohn’s patients after the mastic gum intervention, mainly due to body weight gain (27). Researchers attribute this to a decrease in liquid stool frequency due to mastic gum supplementation, which resulted in better nutrient absorption (27).
Boswellia serrata, known in India as salai guggal, is a staple of Ayurvedic medicine that is referenced in texts such as the Charaka Samhita from the first to second century AD and the Astangahrdaya Samhita from the seventh century AD (35). Extracts of its oleo gum resin contain active constituents called boswellic acids, such as 11-keto-β-boswellic acid (KBA) and acetyl-11-keto-β-boswellic acid (AKBA), which are classified as pentacyclic triterpenes (36).
Boswellic acids down-regulate the expression of pro-inflammatory signaling molecules such as interleukin (IL)-1 IL-2, IL-4, IL-6, interferon (IFN)-γ, and tumor necrosis factor (TNF)-α (35). They likewise inhibit activation of nuclear factor kappa beta (NFκB), a transcription factor that leads to downstream inflammatory cascades (35). Boswellic acids additionally inhibit the formation of reactive oxygen species (ROS), and proteases such as elastase, which play a destructive role in autoimmune disease (35). Thus, boswellia has shown promise in chronic inflammatory disorders, including osteoarthritis, bronchial asthma, rheumatoid arthritis, and inflammatory bowel disease (35).
One randomized, double-blind, placebo-controlled trial of patents with active Crohn’s disease compared 3.6 grams per day of Boswellia serrata extract H15 to mesalazine (37). Both interventions elicited significant decreases in Crohn’s Disease Activity Index (CDAI) and statistical analyses concluded that boswellia had equivalent efficacy to mesalazine (37). Because boswellia was better tolerated, the researchers concluded, “Considering both safety and efficacy of Boswellia serrata extract H15 it appears to be superior over mesalazine in terms of a benefit-risk-evaluation” (37, p. 11).
Medicinal, sociocultural, and psychospiritual use of marijuana, which dates as far back as 2737 BCE by the Chinese, has been intimately woven into the fabric of human ritual (38). Δ9-tetrahydrocannabinol (THC), the best studied psychoactive cannabinoid within cannabis, induces euphoria, relaxation, and modified sensory perception, whereas cannabidiol (CBD) acts peripherally, exerting antipsychotic, analgesic, anti-seizure, anti-anxiety, and anti-inflammatory effects (39). Activation of cannabinoid receptors, which are distributed throughout the nervous system, immune system, and hematopoietic system, are closely tied to diverse functions including memory, cognition, appetite, stress, motivation, and reward, which accounts for their far-reaching therapeutic effects (40, 41). In addition to its applications in cachexia, muscle spasticity, and chronic pain, autoimmune disorders such as Crohn’s disease represent another promising arena for use of cannabis (38).
Initial evidence of the efficacy of marijuana in IBD comes from animal studies. Mouse models have demonstrated that activation of cannabinoid receptors in the colon ameliorates symptoms and histological damage in IBD, and that prolonging the half-life of endogenous cannabinoids confers significant protection against 2,4-dinitrobenzene sulfonic acid (DNBS)-induced Crohn’s (42, 43, 44).
Impressively, in a randomized, double-blind, placebo-controlled clinical trial of Crohn’s patients whose symptoms were resistant to steroids, immunomodulators, and anti-tumor necrosis factor-alpha agents, THC-rich cannabis induced complete remission in 45% of subjects compared to 10% who received placebo (45). Further, a significant decrease in the Crohn’s Disease Activity Index (CDAI) was witnessed in 90% of those in the cannabis group versus 40% of controls (45). In addition to improvements in sleep and appetite, three patients in the THC group were able to taper off of steroid therapy (45). Although this study used marijuana cigarettes containing 115mg of Δ9-tetrahydrocannabinol (THC), cannabis-containing baked goods, tinctures, sprays, teas, oils, and lozenges would circumvent exposure to combustion byproducts and prevent any smoking-associated deleterious health outcomes.
The large-leafed herb Curcuma longa is known as the culinary spice turmeric or Indian saffron (46). Belonging to the ginger family, turmeric is revered in the cuisines of China, India, Iran, Malaysia, Polynesia, and Thailand, but has also been used in traditional Chinese and Ayurvedic medicine for stress, mood disorders, dermatologic diseases, and infection (Kocaadam & Sanlier, 2017). Curcumin is a natural lipophilic polyphenol that is the primary pigment and active constituent within turmeric, acquired from the rhizome of the herb. Research has discovered numerous beneficial effects of curcumin, including antimicrobial, antioxidant, anti-inflammatory, cholesterol-lowering, anticancer, pro-apoptotic, and antiplatelet properties (46). Given its expansive therapeutic profile, curcumin has proven applications in diabetes as well as autoimmune, cardiovascular, and neurological disorders (47).
In an open label study, curcumin was administered to five patients with Crohn’s disease and five patients with proctitis, a mild form of ulcerative colitis (48). Crohn’s patients received 360 milligrams of curcumin three times a day for one month, followed by the same dosage administered four times a day for two months (48). The dosing schedule for proctitis patients was 550 mg of curcumin twice daily for one month, followed by 550 mg three times daily for another month (48).
In 80% of subjects in both groups, curcumin reduced the inflammatory response (48). Improvements were observed in all proctitis patients, with two terminating their 5-aminosalicylic acid (5-ASA) medications, two reducing medication dosages, and one eliminating their prednisone therapy (48). Indices of inflammation, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), reverted to the normal range after the study (48). In Crohn’s patients, the Crohn’s Disease Activity Index (CDAI) fell by an average of 55 points, and reductions in ESR and CRP were also observed (48).
Another double-blind, placebo-controlled, randomized study of patients with mild-to-moderate ulcerative colitis that was uncontrolled despite full-dose mesalamine therapy revealed that 3 grams of curcumin per day reduced mucosal inflammation and induced clinical remission in 53.8% of patients relative to 0% of controls (49). A six month study of quiescent colitis similarly showed that 1 gram of curcumin twice daily plus sulfasalazine (SZ) or mesalamine was superior to these drugs alone in maintaining remission (50).
The therapeutic efficacy of curcumin in IBD is reinforced by animal colitis models, where curcumin inhibits development of colitis induced by chemical agents such as trinitrobenzene sulfuric acid or dinitrobenzene sulfuric acid (DNB) (51, 52). Curcumin may attenuate IBD by suppressing stimulation of NFκB, a transcription factor integral to the production of pro-inflammatory signals such as chemokines and cytokines (Sahl et al., 2003). Likewise, curcumin may mediate immunosuppressive effects by inhibiting activation and infiltration of lymphocytes, or white blood cells, into tissue (48).
Use of Artemisia absinthium, or wormwood, dates back to the Ebers Papyrus, the oldest preserved medical document which is theorized to be a reproduction of the Thoth from 3500 BC (53). Wormwood is referenced several times in the bible and in the opus Historia Naturalis by Roman scholar Pliny the Elder (53). Wormwood was used as an antihelmintic by the ancient Egyptians, and by the ancient Greek physician Hippocrates for rheumatism and menstrual pain (53). Researchers note, “In the Middle Ages, wormwood was used as a purge and vermifuge, and it developed towards a “general remedy for all diseases” and was referred to as “a herb of Mars” for its overarching medical powers” (53). Contemporary studies have also elucidated neuroprotective and heptatoprotective actions of wormwood (54, 55).
In a double-blind, randomized, placebo-controlled trial of patients with active Crohn’s disease, patients in the intervention arm received 500 mg of wormwood three times a day (Omer et al., 2007). In addition to taking medications such as 5-ASA, methotrexate, or azathioprine, all Crohn’s subjects were on a stable dose of prednisone when the study commenced, and underwent a defined tapering schedule two weeks into the trial such that all patient patients were steroid-free after ten weeks (11).
In the wormwood group, 90% of subjects exhibited steady improvement despite the continuous steroid taper, as indicated by their scores on the Crohn’s Disease Activity Index (CDAI) questionnaire, an Inflammatory Bowel Disease Questionnaire (IBDQ), and an 8-item Visual Analogue Scale (VA-Scale) (11). In addition, wormwood improved scores on the 21-item Hamilton Depression Scale (HAMD), indicating that it elicited benefits in the domains of mood and quality of life (11). 65% of patients in the wormwood group achieved near complete resolution of symptoms by the eighth week, which remained throughout the entirety of the observation period up to week twenty without any need for steroids (11). In contrast, none of the placebo group achieved remission, and the condition of controls progressively deteriorated with the omission of steroids, prompting steroids to be re-introduced in 80% of cases after week ten (11).
In another open label trial of patients with active Crohn’s disease receiving conventional medications, patients were randomly allocated to receive 750 milligrams of dried wormwood powder three times a day or placebo for six weeks (56). Average CDAI scores fell by an average of 100 points, and 80% of patients in the wormwood group entered clinical remission compared to only 20% of controls (56). Wormwood also led to significant improvements in the HAD and IBDQ scales (56).
Likewise, significant reductions in levels of tumor necrosis factor (TNF)-α, an inflammatory cytokine that is elevated in active Crohn’s disease, occurred in the wormwood group (56, 57). TNF-α is considered to be intrinsic to the inflammatory response in Crohn’s, so much so that newer generation monoclonal antibody drugs such as infliximab (Remicade) and adalimumab (Humira) specifically block its effects (58). However, TNF inhibitors are associated with significant side effects, including enhanced susceptibility to infections, cancers, and rare neurologic complications (59). Therefore, wormwood may represent a safe alternative and an interim strategy to attenuate inflammation while embarking upon a root-cause resolution approach to treating Crohn’s disease (56).
Acquiring high quality wormwood is imperative, with a standardization of at least 0.2% absinthin (56). Thujone, thujyl alcohol, and other terpene-derivatives which are particularly concentrated in the essential oil of wormwood pose risk of neurotoxicity and seizures at high doses, so researchers recommend that α- and β-thujones should not exceed five parts per million to be safe for human consumption (56).
Because natural and botanical agents are not patentable, they do not represent profitable commodities and the incentive to conduct elaborate clinical trials is absent. There is little fiscal incentive for pharmaceutical industries, who are beholden to shareholder interests, to invest resources in investigating natural substances for which market exclusivity cannot be granted.
However, given the litany of adverse side effects inherent to conventional pharmacotherapy, using these natural agents alongside other holistic strategies represents a viable alternative to maintain or even induce remission in some cases. More research is needed to elucidate optimal dosing regimens, delivery mechanisms, and efficacy alongside other complementary approaches. But, it is undeniable that herbs have multiple advantages over the toxic xenobiotic cocktails of the biomedical paradigm. In addition to eliciting side benefits rather than the side effects observed with synthetic medications, botanical agents have the benefit of synergistic phytochemical constituents, a proven track record spanning thousands of years of history of use, and quintessentially, biocompatibility with human physiology.
To learn more about inflammatory bowel diseases, visit the GreenMedInfo database on the subject by clicking here.
Heading for my second resection surgery in 3 weeks and my goal is to purposely gain body fat.
Studies suggest higher levels of body fat can reduce the effect of muscle catabolism (Ocobock, 2017). In theory, muscle tissue is very difficult to obtain and the body wants to retain it at all cost. Fat is preferentially metabolized and only when fat stores are depleted, does the body resort to breaking down muscle for fuel. Of course, there will be some catabolism without muscle stimulation, but there should be significantly less breakdown than coming into surgery at a lower body fat.
Post-surgery, I will keep up with nutrition, eating as soon as I can tolerate food. I will keep protein intake high, 0.6-0.8g/lb of bodyweight, a high protein intake has a muscle sparing effect. So for me, around 120-160g/day. Fats will be higher and carbohydrates will be on the lower side due to the decreased levels of activity. Calories will be lower than normal to account for being more sedentary and not causing excessive stress on digestive system, allowing my body to heal. I will be supplementing with collagen and bone broth to aid in healing.
Current shape at 201 lbs, 3 weeks prior to surgery
Weight Gaining Tips
I’ve always had an easy time manipulating body fat and weight. Dieting down for a competition or increasing mass in the offseason, I can usually fluctuate 5-10 lbs in a few weeks. I am planning on gaining 10 lbs in the next 3 weeks leading up to surgery. I do my best to stay within 10 lbs of stage weight when I’m in the offseason but in this circumstance, I will be pushing my weight higher.
Scientifically speaking, your body burns a certain number of calories per day at a rest. This is called your BMR, Base Metabolic Rate. To put on muscle and weight, you need to consume more calories than you are burning at rest including additional exercise and activity each day. This is called a caloric surplus. It is very specific to each person, so one persons daily caloric intake will be very different than yours.
I often get asked the best way to gain weight with IBD, and if you’re one of my clients that I coach, you know I am a big fan of increasing dietary fats as an easy way to increase calories. I know a lot of you have a hard time gaining weight, especially with IBD so here’s a few tips.
6 ways to get more calories in
Snack on nuts and seeds between meals (Cation: may be problematic for those with IBD) – Macadamia nuts (highest calorie nuts), cashews, flax seeds, trail mix, almonds, basically any type of nuts that are high in calories.
Cook all veggies and meats with coconut, olive or avocado oils. This is an easy way to increase calories without even knowing it.
Make more smoothies – Drinking your calories can make it easier to get more calories in. Make a high calorie smoothie with banana, figs, berries, chia seeds, keifer, high fat yogurts (assuming no dairy intolerance), oats, almond, peanut or coconut butter. My personal favourite is adding coconut oil to smoothies.
Increase healthy fats – Avocado, eggs and nut butters are all healthy options. Try finding ways to incorporate more of these foods into your meals. Mix avocado in with tuna to make a sandwich. Hard-boil or mix a couple eggs into your rice, making fried rice. Cook your rice with high fat coconut milk, or add a scoop or two of coconut oil into your rice. Add peanut or almond butter to a smoothie.
Eat dried fruits – Although this isn’t a fat, this is a great way to get more carbs in. Try banana chips, dried mango and figs (calorically dense). Find these at your local health food store in the bulk section
Eat ground/fattier meat – Ground meat may be easier to stomach because it may not fill you up as much as other types of meat. Try ground pork or beef for almost twice the calories per serving as ground chicken or turkey (Cation: beef and pork may be harder to digest for those with IBD than chicken or turkey)
Ocobock CJ. 2017. Body fat attenuates muscle mass catabolism among physically active humans in temperate and cold high altitude environments. American Journal of Human Biology 29.
After a few months of tirelessly waiting, I finally got a date for my second small bowel resection surgery. If you’ve been following along, I wrote about my previous health misfortunes this past summer in my last blog, HEALTH UPDATE JULY 2017. I am officially booked for a small bowel resection on October 13, 2017.
I had a colonoscopy three weeks ago (can’t say it was a lot of fun) and results showed no active inflammation! The main stricture, a buildup of scar tissue that is causing the obstructions, is 20-40cm up into the terminal ileum from the large intestine (colon). My Gastro was able to use a pediatric scope to get far enough into the ileum to examine the stricture. I was heavily sedated but I was still able to see the stricture for myself on the screen. The best way I could describe it, is my small intestine looked like a brown paper lunch bag that had been twisted at both ends with an aperture of only 1 cm. That is 1 cm of fixed diameter, which is an extremely small passageway for food to pass through. It’s no wonder, I can’t eat most vegetables, nuts, seeds, skins or red meat. Those foods just do not break down well enough to pass through that small of an opening.
On the positive side, I’ve been feeling slightly better with less pain but have been eating a very restricted diet in the meantime. I have temporarily had to put my career aspirations as a Geologist on-hold until I get this cleared up. I’ve had time to enjoy the summer but I am ready to get this out of the way and get back to normal.
The Road to Recovery
I know a lot of you are probably wondering what the recovery time is for this type of procedure. If, when and will I make it back to where I was previously? Well that all depends on how invasive the surgery is. There is always a risk to any major medical procedure. Risks include, perforation of the intestine, leakages, infections, fissures, ruptures and buildup of additional scar tissue.
I have one specific area that has been identified through various MRI’s, ultrasounds, intestinal X-Rays and a scope. Even with numerous tests, none of these can get a perfect picture of what is going on higher up into the small intestine. If no inflammation is present, it is very difficult to see the severity through these tests. Colonoscopies or endoscopies, are the best procedure to tell what is going on internally without surgically performing a laparoscopy. Due to the narrowing of the small bowel, scopes are only capable of viewing about 20-40 cm into the ileum or the small bowel from the stomach.
It is not only my ileum affected by Crohn’s Disease, several other sections of small bowel are affected by my disease, so additional areas of scarring are very difficult to identify without getting in there with a laparoscope during surgery.
So the short answer is, if all goes well, 3-7 days in the hospital with 4-8 weeks of recovery, all depending on if there are additional areas of scar tissue that need attention. Assuming I am in good health and only the one section in my ileum is removed, 4 weeks is probably a reasonable estimate.
I’m not going to lie, it is always a little stressful going under the knife. I should probably be used to it by now; this will be my 5th surgery and second abdominal surgery. I am looking forward to get this out of the way so I can stop suffering from chronic pain and worrying about what I eat everyday. It is mentally exhausting having my life revolve around stressing about what I am going to eat that day. I have a surgeon I trust, and I am expected to make a full recovery without any noticeable deficiencies due to having a shorter small bowel.
I haven’t had a beef burger, steak or salad in over 5 years, so here’s to hoping I can enjoy some of my favourite foods again!
If you read my last post HEALTH UPDATE JULY 2017, I am currently on the waitlist for my second small bowel surgery. I have been suffering from bowel obstructions since being diagnosed with Crohn’s Disease in 2009. The bowel obstructions are caused by buildup of scar tissue in my small intestine called a stricture. Strictures are areas of scar tissue caused by inflammation within my intestine that does not expand elastically when food tries to pass through the narrowed section causing bowel obstructions.
I already eat a very restrictive diet, but lately I have had to further restrict the foods I am eating or I end up in severe pain. I know a lot of you can relate. Although there are no particular foods or diet that has been proven to cause IBD symptoms, reducing bowel obstructions through diet is absolutely crucial for many of us with Crohn’s Disease.
Personally, I have to avoid certain foods that contain high fibre, stringy foods, skins and seeds just to name a few. When symptoms are bad, I resort to a mostly liquid diet which I find very difficult to sustain for more than a day or two.
My Colorectal surgeon suggested that I check out this link below for specific guidelines on the Bowel Obstruction Diet.
This guide is very well done and gives some fantastic suggestions on how to eat if experiencing partial obstruction symptoms. This guide has three levels of severity of symptoms and the corresponding diets that may help.
I was going to do a full post on exactly what I’m currently eating but this guide basically covers everything. I have been following a modified version of this for the past few years and it has helped keep me out of hospital for the most part. As my symptoms worsened, I had to change my diet accordingly, removing most vegetables even going to the point of a liquid diet.
My Tips for Covering Nutritional Deficiencies
If you’re anything like me, the number one thing I have problems getting enough of is vegetables. I have a very hard time passing vegetables through the scarred sections of my intestine. I have found a few ways to still get vegetables without causing obstructions so here are a few tips. Just to be clear, I am not a registered dietician. All information is what has personally worked for me and are merely suggestions. Consult a physician before taking any dietary supplements or advice.
Blend your greens. I cannot eat greens but I have found significantly less distress when I blend them well and try to reduce the amount of pulp.
Take a greens supplement. I personally like Greens+ but any quality greens supplement will help you increase your vegetable intake.
Juice! If you have a juicer, make your own juice with or without pulp. Alternatively, you can buy your juice from various places but this can get expensive quickly.
Cover your bases with vitamins. Although this is not as good as getting your nutrients from foods, vitamins can help cover deficiencies when you are having a hard time getting adequate nutrients in. Vitamin D, Calcium, multi-vitamin, fish oil, magnesium, zinc, iron, probiotics, B12 and Vitamin C. Again, always check with your doctor before taking any supplements.
If you cannot tolerate nuts or seeds, nut butters or oils are a great way to get your healthy fats in. Peanut butter, almond butter, coconut oil and avocado oil are all easier to digest than eating the whole, natural form. You can even add these to your smoothies for extra calories.
Here’s my latest health update! A lot of you seem to be very interested in my latest misfortunes and I’m tired of explaining my situation, so here it is.
Emergency Room Trip #1
In early June 2017, two few weeks after competing in Men’s Physique at the BC Provincial Championships, I headed to emergency after suffering from severe but all too familiar abdominal pain and cramping. Severe bloating, nausea and unbearable pain that felt like I had been stabbed and someone was twisting the knife; I knew as soon as it started that I was having another bowel obstruction.
I have been suffering from bowel obstructions since being diagnosed with Crohn’s Disease in 2009. The bowel obstructions are caused by a buildup of scar tissue in my small intestine called a stricture. Strictures are areas of scar tissue caused by inflammation within my intestine that does not expand elastically when food tries to pass through the narrowed section causing bowel obstructions.
Fortunately, I was not admitted and sent home because the partial obstruction passed. I took it easy for the next few days but I was still having daily, severe abdominal pain. I flew the Calgary the following week for my commencement ceremony for completing my Bachelor’s of Science degree, majoring in Geology from the University of Calgary! I met with my GI that I had been with for the past 4 years since I relocated to Calgary for my undergraduate degree and he wanted to keep me off steroids at all cost due to previous issues with Prednisone in the past. He told me to come to his office to pick up an extra two Humira syringes to double up on my already doubled dose of Humira (I am on weekly Humira injections) to see if that would calm things down.
$1200 of medication on the floor of a Starbucks bathroom
Long story short, I didn’t have a car on my trip because I flew, so I made the trek across Calgary to the far end of the city to pick up my Humira. It was over 30°C degrees and I didn’t have an ice pack to keep the medication cold. I felt absolutely terrible so I walked to the nearest bathroom to inject in hope of getting some relief. Feeling like a junkie, I found a Starbucks and went into the bathroom to inject. I didn’t realize they gave me the Humira auto-inject pens this time that I had not used before, I usually get the pre-filled syringes. In a lot of pain, I just wanted to inject the medication in hope that I would feel better and it looked pretty straightforward but there was not any instructions in the box. I took the cap off, held the syringe to my stomach and pressed the button. It clicked but nothing happened. I looked at the auto-injector again, and it looked like I had to twist the pen to expose the needle. As I start to twist, $1200 of medication squirts all over the floor of the Starbucks bathroom. I sat on the floor of the bathroom, had a bit of a meltdown and tried to figure out what to do next.
Rattled and in severe pain, I travel all the way back across Calgary to visit my pharmacist to see if I can get another syringe. He shows me how to properly inject the Humira pen and tells me to contact Humira to get a replacement. I injected two doses of Humira later that day, and luckily got another replacement mailed to me to inject two doses the following week after I flew back home to Vancouver Island.
With no improvement in symptoms or pain, my Calgary GI referred me to the nearest local GI in Victoria, BC, 2 hours away. Due to a very limited number of gastroenterologists on Vancouver Island for over 750,000 people, I could not get in to see him for a month. Thankfully, he did a thorough overview of my previous history and we spoke over the phone. He suggested the next step was to go on a short but high dose of prednisone.
Prednisone – The Devil’s Tic-Tacs & ER Trip #2
Prednisone is a corticosteroid. Differing from anabolic steroids, corticosteroids are catabolic and act quickly to reduce inflammation by dampening the immune system responsible for creating inflammation.
I have been on Prednisone many times in the past and have had great success in reducing Crohn’s symptoms but not without a plethora of side effects. Side effects I have faced include rapid weight gain, increased appetite, muscle loss, acne, difficulties sleeping and immunosuppressant complications just to name a few. Prednisone is a horrible yet amazing drug and is sometimes a necessary evil.
I was on Prednisone for a week with no improvement in symptoms or pain. My series of misfortunes continue, as I ended up in the ER again after being on prednisone for a week. I woke up one morning, unable to move my arm with a seized and extremely swollen elbow. It felt like I had a broken arm again. The ER doctor took a look and said I had a severe infection in my elbow. Being on high doses of biologics and prednisone which are both immunosuppressant medications, it wrecked havoc on my immune system and my body could not fight off an infection caused by a ruptured bursa sac in my elbow. Treating one problem and creating another, I was on antibiotics for a week and that cleared things up.
Following the infection, I got an MRI done to confirm our suspicion that the pain was likely not inflammation related. The double dose of Humira and the cycle of Prednisone should have mopped up any inflammation present. The severe pain I have been having daily for two months is the result of a build-up of scar tissue called an intestinal stricture.
A new Gastroenterologist, Colorectal Surgeon and “the most well-nourished Crohn’s patient”
In mid July 2017, I got in to see my new GI to discuss surgical options. Upon first impression, he took one look at me and said that I was “the most well-nourished Crohn’s patient” he’s ever seen, so I must be doing something right. I was very impressed, he was very thorough and seemed to genuinely care about my well-being.
Currently sitting at 200 lbs, 2 months post show, 9 lbs above stage weight but having a hard time maintaining a consistent diet while battling chronic pain
I was referred by my new GI to a Colorectal Surgeon in Victoria, BC as well. I met with the surgeon and the consensus was to go ahead with my second surgery. The plan is to remove the scarred section in my ileum and install stricturoplasties in other scarred sections. The problem is that there are at least three other diseased sections that may also have intestinal strictures present. Due to the location in my small bowel, a scope is unable to get that far into the small intestine and that area is difficult to see on an MRI without inflammation present. There is a bit of a gamble with the surgery as it could be a much more complex than a typical small bowel resection.
The pain I have been experiencing is technically not an emergency situation unless I get hospitalized again, I am currently on the waitlist for surgery but it is not looking like I will be able to get in until October at the earliest. Unable to work, I am still experiencing a lot of pain but doing my best to still enjoy the summer and workout when I can. I have been having a hard time maintaining a consistent diet lately. I have restricted my already very restricted diet again, in an attempt to reduce the chronic pain I have been facing and I go into further detail in THE BOWEL OBSTRUCTION DIET – Restricting my already restricted diet.