Fish Oil & Ulcerative Colitis
Ulcerative colitis (UC) is a chronic disease characterized by bloody diarrhea and an inflamed colon. UC is relatively common but remains poorly understood. Diagnosis must be made by a healthcare practitioner—typically a gastroenterologist. Irritable bowel syndrome, a completely unrelated and less serious condition, was sometimes called mucous colitis in the past. As a result, the general term "colitis" is still sometimes used inappropriately to refer to irritable bowel syndrome. It is critical that people who are diagnosed with "colitis" find out whether they have irritable bowel syndrome or ulcerative colitis.
Conventional treatment for UC is often essential in emergency circumstances. However, conventional treatments for ulcerative colitis frequently offer only a partial solution and in some cases are accompanied by significant side effects. Because of the limitations of conventional therapy, many people with UC look to natural medicine in an attempt to deal with their condition. All people with UC wishing to use natural approaches should work with a doctor.
Lifestyle changes that may be helpful:
Smokers have a lower risk of UC for unknown reasons. The nicotine patch has actually been used to induce remissions in people with UC,1 although this treatment has been ineffective in preventing relapses.2 On the other hand, Crohn’s disease, which is in many ways similar to UC, is made worse by smoking.3 Despite the possible protective effect of smoking in individuals with UC, a strong case can be made that risks of smoking outweigh the benefits. Even the use of nicotine patches remains experimental and carries its own side effects.Dietary changes that may be helpful:
Although one study showed that high sugar intake was associated with a nearly threefold increase in risk for UC,4 other research failed to find any association with sugar intake.5 6 In an Israeli study, individuals with a high intake of animal fat and cholesterol had a four fold increase in risk, compared with people who consumed less of these fats.7 A study from Japan also found that ingestion of certain high-fat foods (particularly margarine) was associated with increased risk.8 Although these associations do not prove cause-and-effect, reducing one’s intake of refined sugar and animal fats is often recommended as a means of improving overall health.More than a half-century ago, several doctors reported that food allergies play an important role in some cases of UC.9 10 Since that time, many doctors have observed that avoidance of allergenic foods will often reduce the severity of UC and can sometimes completely control the condition. However, the relationship between food allergies and UC remains controversial11 and is not generally accepted by the conventional medical community. People who wish to explore the possibility that food sensitivities might trigger their symptoms should see a doctor.
Nutritional supplements that may be helpful: UC is linked to an increased risk of colon cancer. Studies have found that people with ulcerative colitis who have been taking folic acid supplements or who have high blood levels of folic acid have a reduced risk of colon cancer compared with other individuals who have UC.12 13 14 Although these associations do not prove that folic acid was responsible for the reduction in risk, this vitamin has been shown to prevent experimentally induced colon cancer in animals.15 Low folic acid levels have been found in more than half of people with UC.16 Individuals with UC who are taking the drug sulfasalazine, which inhibits the absorption of folic acid,17 are at particularly high risk of developing folic acid deficiency. Folic acid supplementation may therefore be important for many people with UC. However, since taking folic acid may mask the diagnosis of vitamin B12 deficiency, individuals with UC who wish to take folic acid should be monitored by a physician.
Ingestion of alcohol, which is known to promote folic acid deficiency, has also been linked to an increased risk of colon cancer.18 Consequently, people with UC should keep alcohol intake to a minimum.
Because ulcerative colitis is an inflammatory condition and
Fish oil has anti-inflammatory activity, Fish oil has been tested as a potential remedy for people with UC. In a four-month, double-blind study, people with UC who were given Fish oil (containing 3.2 grams of EPA and 2.2 grams of DHA per day—the two important fatty acids found in Fish oil) required lower levels of prescription anti-inflammatory drugs.19 Fish oil supplementation also resulted in other improvements, such as weight gain and reduced intestinal inflammation. In another study, Fish oil reduced the need for steroid medication in people with active UC, but did not prevent relapses in people whose disease was in remission.20 Other research shows at least some positive effects from the use of Fish oil for people with UC.21 22A fatty acid called butyrate, which is synthesized by intestinal bacteria, serves as fuel for the cells that line the small intestine. Administration of butyrate by enema has been found to produce marked improvement in some individuals with UC in most,23 24 25 26 27 28 but not all, preliminary trials.29 Butyrate taken by mouth is not likely to be beneficial, as sufficient quantities would not reach the colon after oral administration. Although butyrate enemas are not widely available, they can be obtained by prescription through a compounding pharmacist.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.Herbs that may be helpful: One study has been done using the gum resin of boswellia, an Ayurvedic herb.30 Administration of boswellia (350 mg three times per day for six weeks) was found to be as effective as the standard drug sulfasalazine.
Aloe vera juice has been used by some doctors for people with UC. Although aloe is known to have anti-inflammatory activity, it has not been studied specifically in people with UC. The same is true of other traditional anti-inflammatory and demulcent herbs, including calendula, flaxseed, licorice, marshmallow, myrrh, and yarrow. Many of these herbs are most effective, according to clinical experience, if taken internally as well as in enema form.31 Enemas should be avoided during acute flare-ups, but are useful for mild and chronic inflammation. It is best to consult with a doctor experienced with botanical medicine to learn more about herbal enemas before using them. However, more research needs to be done to determine the effectiveness of these herbs.
German doctors practicing phytotherapy have recommended chamomile for individuals with colitis.32 A cup of strong tea drunk three times per day is standard, along with enemas. Enemas of oil of St. John’s wort may also be beneficial.33 Consult with a doctor before using St. John’s wort oil enemas.
In an open study, people with ulcerative colitis remained in remission just as long when they took 20 grams of ground psyllium seeds twice daily with water as when they took the medication mesalamine.34 The combination of the two was slightly more effective than either alone. Controlled studies are now needed to follow up this intriguing observation.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.Checklist for Ulcerative Colitis
|
Ranking |
Nutritional Supplements |
Herbs |
|
Primary |
Fish oil |
|
|
Secondary |
Butyrate (enema) Folic acid |
Boswellia |
|
Other |
|
Aloe Calendula Chamomile Flaxseed Licorice Marshmallow Myrrh Psyllium St. John’s wort Yarrow |
Information about the effects of a particular supplement or herb on a particular condition has been qualified in terms of the methodology or source of supporting data (for example: clinical, double blind, meta-analysis, or traditional use). For the convenience of the reader, the information in the table listing \ the supplements for particular conditions is also categorized. The criteria for the categorizations are: "Primary" indicates there are reliable and relatively consistent scientific data showing a health benefit. "Secondary" indicates there are conflicting, insufficient, or only preliminary studies suggesting a health benefit or that the health benefit is minimal. "Other" indicates that an herb is primarily supported by traditional use or that the herb or supplement has little scientific support and/or minimal proven health benefit.
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20. Hawthorne AB, Daneshmend TK, Hawkey CJ, et al. Treatment of ulcerative colitis with fish oil supplementation: a prospective 12 month randomised controlled trial. Gut 1992;33:922–8.
21. Aslan A, Triadafilopoulos G. Fish oil fatty acid supplementation in active ulcerative colitis: a double-blind, placebo-controlled, crossover study. Am J Gastroenterol 1992;87:432–7.
22. Salomon P, Kornbluth AA, Janowitz HD. Treatment of ulcerative colitis with fish oil n-3-omega-fatty acid: an open trial. J Clin Gastroenterol 1990;12:157–61.
23. Scheppach W, Sommer H, Kirchner T, et al. Effect of butyrate enemas on the colonic mucosa in distal ulcerative colitis. Gastroenterol 1992;103:51–6.
24. Scheppach W. Treatment of distal ulcerative colitis with short-chain fatty acid enemas. A placebo-controlled trial. German-Austrian SCFA Study Group. Dig Dis Sci 1996;41:2254–9.
25. Vernia P, Marcheggiano A, Caprilli R, et al. Short-chain fatty acid topical treatment in distal ulcerative colitis. Aliment Pharmacol Ther 1995;9:309–13.
26. Steinhart AH, Brzezinski A, Baker JP. Treatment of refractory ulcerative proctosigmoiditis with butyrate enemas. Am J Gastroenterol 1994;89:179–83.
27. Patz J, Jacobsohn WZ, Gottschalk-Sabag S, et al. Treatment of refractory distal ulcerative colitis with short chain fatty acid enemas. Am J Gastroenterol 1996;91:731–4.
28. Breuer RI, Buto SK, Christ ML, et al. Rectal irrigation with short-chain fatty acids for distal ulcerative colitis. Preliminary report. Dig Dis Sci 1991;36:185–7.
29. Steinhart AH, Hiruki T, Brzezinski A, Baker JP. Treatment of left-sided ulcerative colitis with butyrate enemas: a controlled trial. Aliment Pharmacol Ther 1996;10:729–36
30. Gupta I, Parihar A, Malhotra P, et al. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res 1997;2:37–43.
31. Weiss RF. Herbal Medicine. Beaconsfield, UK: Beaconsfield Publishers Ltd, 1989:114–5.
32. Weiss RF. Herbal Medicine. Beaconsfield, UK: Beaconsfield Publishers Ltd, 1989:26.
33. Weiss RF. Herbal Medicine. Beaconsfield, UK: Beaconsfield Publishers Ltd, 1989:114–5.
34. Fernandez-Banares F, Hinojosa J, Sanchez-Lombrana JL, et al. Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Am J Gastroenterol 1999;94:427–33.