NIMBAL Therapy

Anyone picked this up yet?

https://amzn.com/0692430997

David Suskind is a pediatric gastroenterologist at Seattle Children's and is their "IBD guy." Looks like he's done some small studies on the SCD diet and IBD in children, and has recently put this book out.

This may be the first acknowledgement from the M.D. community (typically they stay out of questions of nutrition) of the role nutrition (and specifically the SCD diet) plays in IBD.

Cool! I've been using variation's of the SCD diet for 7 years since being diagnosed after reading the book Breaking the Vicious Cycle. David Suskind also has studied Fecal Microbiota Transplants in IBD.

northwesterner said:

This may be the first acknowledgement from the M.D. community (typically they stay out of questions of nutrition) of the role nutrition (and specifically the SCD diet) plays in IBD.

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I don't know if that's fair though. There are countless studies regarding micro and macronutrients that are involved in the immune system and repair of the intestines. Vitamin D, A, Glutamine, etc.

I think the reason doing studies about SCD is so unpopular is because it would never be considered a healthy diet on its own. The SCD diet is not healthy or balanced in any shape or form. 60% of your calories should be coming from carbs, an SCD diet without complex carbs is incredibly restrictive. When doctors have trouble keeping the weight on for many people with CD, and are forced to add glucose 5% and EN, the last thing these doctors want to do is limit carb intake, which these people desperately need. The first thing that takes priority is making sure CD patients maintain their weight and making sure they have the energy to recover.

Primum non nocere. A diet like SCD with extreme restrictions in calorie intake, has the potential to be very harmful to patients. Malnourishment is a risk factor.

I'm personally very sceptical of the SCD diet, I have never seen a convincing theory as to why putting such a limit on carbs would benefit anyone. If anything such extreme restrictions in nutrition will lead to malnourishment. The outcome is much worse for people with severe malnourishment, it's a great risk factor for people with crohn's disease. You need your carbs for energy, you need them for protein synthesis, you need them to recover, there is a reason why every malnourished person that comes into ER is treated with glucose IV, you can not recover without them.

Restricting bacteria of carbs will somehow help eliminate bad bacteria is a nice idea in theory, in practice this doesn't work. The human body will suffer long before the bacteria does. They tried giving a diet low with iron to cows to prevent the spread of certain mycobacteria, well the cows died from mineral defficiency, the bacteria didn't.


There are studies about very specific substances like maltodextrin, that clearly aid in the growth of E. Coli, and it's perfectly normal to try to limit your intake of it, how you get your carbs doesn't matter in the end, it all turns into blood glucose. But large calorie restrictions like the SCD that restricts all complex carbs, is something you won't see many doctors agree with.

kiny said:

I don't know if that's fair though. There are countless studies regarding micro and macronutrients that are involved in the immune system and repair of the intestines. Vitamin D, A, Glutamine, etc.

I think the reason doing studies about SCD is so unpopular is because it would never be considered a healthy diet on its own. The SCD diet is not healthy or balanced in any shape or form. 60% of your calories should be coming from carbs, an SCD diet without complex carbs is incredibly restrictive. When doctors have trouble keeping the weight on for many people with CD, and are forced to add glucose 5% and EN, the last thing these doctors want to do is limit carb intake, which these people desperately need. The first thing that takes priority is making sure CD patients maintain their weight and making sure they have the energy to recover.

Primum non nocere. A diet like SCD with extreme restrictions in calorie intake, has the potential to be very harmful to patients. Malnourishment is a risk factor.

I'm personally very sceptical of the SCD diet, I have never seen a convincing theory as to why putting such a limit on carbs would benefit anyone. If anything such extreme restrictions in nutrition will lead to malnourishment. The outcome is much worse for people with severe malnourishment, it's a great risk factor for people with crohn's disease. You need your carbs for energy, you need them for protein synthesis, you need them to recover, there is a reason why every malnourished person that comes into ER is treated with glucose IV, you can not recover without them.

Restricting bacteria of carbs will somehow help eliminate bad bacteria is a nice idea in theory, in practice this doesn't work. The human body will suffer long before the bacteria does. They tried giving a diet low with iron to cows to prevent the spread of certain mycobacteria, well the cows died from mineral defficiency, the bacteria didn't.


There are studies about very specific substances like maltodextrin, that clearly aid in the growth of E. Coli, and it's perfectly normal to try to limit your intake of it, how you get your carbs doesn't matter in the end, it all turns into blood glucose. But large calorie restrictions like the SCD that restricts all complex carbs, is something you won't see many doctors agree with.

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Now clearly the mileage will vary from one crohn's sufferer to another but Ketogenic diets have been used therapeutically for epilepsy for a long time and show great promise for their cancer fighting properties and help many control weight gain.

Ketogenic diets are primarily fat-based and very very low carb, it's entirely possible to have 0 carbs on a ketogenic diet.

The problem comes down to whether a crohn's sufferer's appetite and food restrictions allow them to consume enough fats and meat to meet their macros and calorie needs. (Fat is in fact more important because too much protein will break ketosis and reset to a normal diet via gluconeogenesis of the protein)

But if you aren't digesting most of your 3000+ calorie carb-heavy diet (like I wasn't) then you get no benefit from all those calories anyway - or wose, they do you harm.

When I went from a 4000 calorie diet to a 1500 calorie diet my weight loss was very slow and that suggested that, at a calorie intake that should put me at at least 2 lb. weight gain a week until I stabilize at about 180, I was not digesting most of that food.

If a ketogenic diet can make someone asymptomatic I think it would be much more beneficial than a normal, balanced, carb-heavy diet that makes them ill and prevents absorption of nutrients.

But I say this as someone that can eat a pound of steak in one sitting without ill effect but I cannot find a single complex carb I can eat without adverse reaction on some level.

I tried SCD a few years back and just couldn't get enough calories because it's such a restrictive diet. It's a lifestyle and requires a lot of effort that I couldn't sustain. I lost weight while on it.

I just don't think we know enough. Even if the diet influences the microbiota diversity, studies would have to be done to control for that.

What we eat changes the type of bacteria within the microbiome and can cause them to get out of balance and trigger our immune system to attack our bowels

I had a quick look at the book on Amazon, but this often repeated, but completely unproven statement immediately put me off

kiny said:

Restricting bacteria of carbs will somehow help eliminate bad bacteria is a nice idea in theory, in practice this doesn't work. The human body will suffer long before the bacteria does.

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I think you need to identify the bacteria you are trying to prevent from growing and its primary energy source before you can try diet changes. Given no one has done that, these diets, as you say are unlikely to work.

kiny said:

They tried giving a diet low with iron to cows to prevent the spread of certain mycobacteria, well the cows died from mineral defficiency, the bacteria didn't.

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Mycobacteria Tuberculosis and probably Mycobacterium Avium ss Paratuberculosis use iron as an energy source, so if you restrict iron intake, I suspect the bacteria will gobble up all of the available iron leaving the animal in serious trouble. It would have been interesting to try the opposite, a diet high in iron too.

JMC said:

I think you need to identify the bacteria you are trying to prevent from growing and its primary energy source before you can try diet changes. Given no one has done that, these diets, as you say are unlikely to work.

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Actually they have.


Summary of diet-induced dysbiosis.

Diet Bacteria Altered Effect on Bacteria References
High-fat
Bifidobacteria spp. Decreased (absent) [45]
High-fat and high-sugar
Clostridium innocuum, Catenibacterium mitsuokai and Enterococcus spp. Increased [18]
Bacteroides spp. Decreased [18]

Carbohydrate-reduced
Bacteroidetes Increased [49]

Calorie-restricted
Clostridium coccoides, Lactobacillus spp. and Bifidobacteria spp. Decreased (growth prevented) [48]

Complex carbohydrates
Mycobacterium avium subspecies paratuberculosis and Enterobacteriaceae Decreased [49]
B. longum subspecies longum, B.breve and B. thetaiotaomicron Increased [53]
Refined sugars
C. difficile and C. perfringens Increased [54,55]
Vegetarian
E. coli Decreased [56]
High n-6 PUFA from safflower oil
Bacteroidetes Decreased [59,60]
Firmicutes, Actinobacteria and Proteobacteria Increased [59,60]
δ-Proteobacteria Increased [61]
Animal milk fat
δ-Proteobacteria Increased [62]


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3448089/

InstantCoffee said:

Actually they have.


Summary of diet-induced dysbiosis.

Diet Bacteria Altered Effect on Bacteria References
High-fat
Bifidobacteria spp. Decreased (absent) [45]
High-fat and high-sugar
Clostridium innocuum, Catenibacterium mitsuokai and Enterococcus spp. Increased [18]
Bacteroides spp. Decreased [18]

Carbohydrate-reduced
Bacteroidetes Increased [49]

Calorie-restricted
Clostridium coccoides, Lactobacillus spp. and Bifidobacteria spp. Decreased (growth prevented) [48]

Complex carbohydrates
Mycobacterium avium subspecies paratuberculosis and Enterobacteriaceae Decreased [49]
B. longum subspecies longum, B.breve and B. thetaiotaomicron Increased [53]
Refined sugars
C. difficile and C. perfringens Increased [54,55]
Vegetarian
E. coli Decreased [56]
High n-6 PUFA from safflower oil
Bacteroidetes Decreased [59,60]
Firmicutes, Actinobacteria and Proteobacteria Increased [59,60]
δ-Proteobacteria Increased [61]
Animal milk fat
δ-Proteobacteria Increased [62]


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3448089/

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Although interesting, it's a pretty speculative paper and the conclusions are weak. Where are all the people who have been cured of Crohn's by changing their diet? As far as I know, they don't exist and plenty have tried. Prof John Hunter advocated an exclusion diet (LOFLEX) as a way to "cure" Crohn's but few people could tolerate following it and most immediately relapsed once they went back to a "normal" diet.

I remain firmly of the opinion that Crohn's is caused by a pathogen and dysbiosis is a secondary effect, not the primary cause. If someone was to step forward with a simple method, a well defined diet for example, which reset my microbiome and could cure me or even improve my health significantly I would be delighted.

JMC said:

Although interesting, it's a pretty speculative paper and the conclusions are weak. Where are all the people who have been cured of Crohn's by changing their diet? As far as I know, they don't exist and plenty have tried. Prof John Hunter advocated an exclusion diet (LOFLEX) as a way to "cure" Crohn's but few people could tolerate following it and most immediately relapsed once they went back to a "normal" diet.

I remain firmly of the opinion that Crohn's is caused by a pathogen and dysbiosis is a secondary effect, not the primary cause. If someone was to step forward with a simple method, a well defined diet for example, which reset my microbiome and could cure me or even improve my health significantly I would be delighted.

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If the dysbiosis is an extinction of a necessary bacteria, you won't be able to eat it back in... except through FMT.

Antibiotics are known to wipe out a significant diversity of intestinal bacteria and could take years to recover from, if ever. They've also been strongly linked to crohn's.

My take on diet or pathogens with IBD conditions is that what ever path one takes, a wall one will run into a healing. From what I've read in the animal kingdom humans are poor at regeneration and healing.

As an example of that, of late I've had very good success at improving my colitis condition with changing my diet. The diet I'm on has been followed since March, but some foods avoided since December. My stomach is greatly improved from the limited diet I'm following. Most importantly my energy levels are much elevated.

My great frustrating is healing time. There are all kinds of theories on how long it takes to heal. Some say healing can be done in months. Others I've seen mention up to 5 years. That's a heck of a long time to follow an elimination diet, not knowing what food(s) are a problem. That isn't realistic. If one follows a diet, you want to be exact with it. No cheating would be allowed if one hopes to heal, at least that is my thinking.

So with that I've sometimes wondered if an answer for Crohns, Colitis, etc hasn't been found, with some of the different ideas tried and promoted. The big problem could be healing, or knowing that one is following a correct path toward good health.

As an other example, I've been doing great of late as mentioned. From time to time though I can become terribly ill for a few days. I know some activities can make me ill, such as eating to much fiber, exercising to much, driving in a car for a long period of time, etc. So in some respects it comes back to how long it takes to heal, and taking in all the other factors outside of diet that can make me ill. It causes confusion.

Outside of diet, i've been doing some energy ideas in hopes of helping along my healing process. It's based upon the writings of Dr. Becker. He's written a few books which can be seen on Amazon. In the 50s, 60s, and 70s, he conducted studies on regeneration and healing. He found the importance of electrical signally when it comes to healing. His work is best known for a PEMF type electrical machine implanted into broke bones, when bones are not healing on their own.

On probiotics and the SCD diet, I saw the Crohns and Colitis Society is now conducting a large study on the SCD diet. The announcement was made early this year. It made me laugh in some respects - now they do a study. The SCD diet has been around for a long time. I suspect the SCD probiotics study is being done now due to the money being made with probiotics. It seems large companies are involved in the probiotic business advertising on TV and in magazines, so it makes some sense. At least that is my guess. I hope they work as advertised. I've unfortunately not had success with any of the probiotics I've tried. I've seen others have done better with them though. Maybe my lack of success has to do with poor healing and length of time one should take probiotics.

I think the fact they are studying the effect of diet is great. What I don't think is great is how this book claims their diet is "groundbreaking". Also the study this book appears to be based on (his most recent according to Seattle children's was only 7 children and didn't include scope results)

The results as per the study : "RESULTS: Seven children with Crohn disease receiving the SCD and no immunosuppressive medications were retrospectively evaluated. Duration of the dietary therapy ranged from 5 to 30 months, with an average of 14.6±10.8 months. Although the exact time of symptom resolution could not be determined through chart review, all symptoms were notably resolved at a routine clinic visit 3 months after initiating the diet. Each patient's laboratory indices, including serum albumin, C-reactive protein, hematocrit, and stool calprotectin, either normalized or significantly, improved during follow-up clinic visits." (http://www.ncbi.nlm.nih.gov/m/pubmed/24048168/)
Something to look further into but not enough to be groundbreaking I would say.

I think, no matter the approach, it's important to just see that diet is a form of symptom management and not a cure. If you cannot lapse from your diet, then you are not cured.

I do think it's important doctors realize that not only is it an effective form of symptom management, but for some like myself may be the only effective form. No amount of humira or prednizone could counter what happens when I ate trigger foods.

InstantCoffee said:

If the dysbiosis is an extinction of a necessary bacteria, you won't be able to eat it back in... except through FMT.

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What caused the extinction of the necessary bacteria and for what are they necessary? I would argue, if we have lost necessary bacteria, their role is to kill or damage pathogens we are ingesting. FMT in that case is acting like an antibiotic as there are bacteria in healthy faeces which can kill (directly or indirectly) the nasty bacteria. Dysbiosis is a side effect, not the cause.

InstantCoffee said:

Antibiotics are known to wipe out a significant diversity of intestinal bacteria and could take years to recover from, if ever. They've also been strongly linked to crohn's.

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You know the theory of antibiotics and how they were developed?

InstantCoffee said:

I think, no matter the approach, it's important to just see that diet is a form of symptom management and not a cure. If you cannot lapse from your diet, then you are not cured.

I do think it's important doctors realize that not only is it an effective form of symptom management, but for some like myself may be the only effective form. No amount of humira or prednizone could counter what happens when I ate trigger foods.

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I agree, it would be ideal if one could eat what ever one wants to. Of course hard to say what is the cause of our conditions.

I'm in the same boat as you. Medications didn't work for me. It isn't ideal but I'm pleased that diet has been able to help control my colitis. I wish I could heal quicker, but the healing process on the latest diet I'm following seems to be coming along.

I haven't read all that much on allergies and what causes them, but have found it interesting mentions on organ donations and allergies showing up in the organ recipient. Some write ups I've seen have said, if a person has a peanut allergy, dies and the liver is transplanted to another person, the peanut allergy can show up in the organ recipient. The peanut allergy though tends to not be permeant. The allergy might last for a year or two, and then for some unknown reason go away.

In some respects it reminded me of Dr. Hunter's mentions with patients. He has said with some Crohns patients, around 50%, after a number of years the offending allergen food can be eaten without issue. The doctor speculated that might be due to a bacteria/fungal die off but he wasn't sure. It was just a guess on his part.

JMC said:

What caused the extinction of the necessary bacteria and for what are they necessary? I would argue, if we have lost necessary bacteria, their role is to kill or damage pathogens we are ingesting. FMT in that case is acting like an antibiotic as there are bacteria in healthy faeces which can kill (directly or indirectly) the nasty bacteria. Dysbiosis is a side effect, not the cause.

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What the good bacteria do is a few things. The indirectly kill/inhibit bacteria via the short chain fatty acids they produce to lower intestinal ph, and can also fight them more directly. but they also send signals to immune cells which activate inflammatory response and when to turn that response back down. so no you get the concept of when the correct signals aren't being sent to the immune system from the good bacteria, this leads to chronic inflammation. That's just the general concepts.