Crohn’s disease is a chronic illness that can affect any part of the gastrointestinal tract but mostly affects the small and large intestines. People with Crohn’s disease often have inflammation of the large bowel (Crohn’s disease is an inflammatory bowel disease or IBD). This colitis causes abdominal pain, cramping, diarrhea, along with bleeding and infections in the gastrointestinal tract. Crohn’s disease can interfere with a person’s ability to absorb nutrients, leading to malnutrition and weight loss. The medical community is debating whether it is possible to treat experimental colitis with fat-derived stem cells.
The standard medical treatment for Crohn’s disease involves one or more powerful drugs. When the disease flares up, patients usually must take steroids either orally or intravenously. They may also receive disease-modifying therapy such as immunomodulators and biologic medications. Many patients do enjoy remission once they receive these powerful drugs; however, side effects can be difficult to tolerate. Patients who cannot tolerate these powerful drugs or do not achieve disease remission may have to take steroids every day. Chronic steroid use has many severe and sometimes permanent side effects. If these treatments fail, patients may need to have surgery to remove a portion of their intestines that have been damaged by Crohn’s disease.
In an effort to find safe and effective treatments for Crohn’s disease, researchers have been testing stem cells in laboratory animals. In one study, scientists used a chemical to cause colon inflammation (colitis) in mice. This chemical causes many of the symptoms of humans with Crohn’s disease experience such as diarrhea, tissue damage, and weight loss. The researchers then treated some of the mice with mesenchymal stem cells gathered from human fat tissue (adipose) to see if stem cells could improve the symptoms.
Remarkably, human stem cell treatment reduced diarrhea, inflammation, and disease severity in mice with colitis. The chemical colitis caused mice to lose approximately 15 to 20% of their body weight. Mice that received stem cell treatment regained most of the weight they had lost. Researchers also noted that mice treated with adipose-derived mesenchymal stem cells lived significantly longer than those that did not receive stem cell treatment.
Of course, this research was performed in laboratory animals, but it lays important groundwork for testing in humans. Indeed, since the publication of this report, researchers have been able to show that adipose-derived stem cells helped patients with Crohn’s disease. This exciting work will no doubt lead to future studies that may help pave the way to wider use of stem cells in the treatment of inflammatory bowel disease, such as Crohn’s disease.
Reference: Gonzalez, M. (2009). Adipose-Derived Mesenchymal Stem Cells Alleviate Experimental Colitis by Inhibiting Inflammatory and Autoimmune Responses. Gastroenterology. Volume 136, Issue 3, March 2009, Pages 978-989
Mesenchymal stem cells have two unique and powerful properties that make them the focus of intense scientific research. First, mesenchymal stem cells can escape recognition by the immune system. In other words, when mesenchymal stem cells are infused into the body, the immune system does not recognize them as foreign and does not react to them. If the immune system did respond to the stem cells, it would cause an aggressive and potentially deadly allergic or immunologic response. Second, mesenchymal stem cells have the power to inhibit the immune system. This means mesenchymal stem cells could be used to treat immunological and autoimmune diseases such as Rheumatoid Arthritis, Systemic Lupus Erythematosus, Multiple Sclerosis, and Crohn’s Disease, among others. In essence, mesenchymal stem cells can affect the immune system without triggering an inflammatory response making them an ideal treatment for these diseases.
For some time, mesenchymal stem cells extracted from bone marrow were thought to be the only type of mesenchymal stem cells capable of beneficially affecting the immune system. This fact is not necessarily bad, but it does mean that mesenchymal stem cell donors must undergo a bone marrow procedure, which can be painful and expensive. It would be far better if doctors could use mesenchymal stem cells taken from easier-to-get tissues such as fat (adipose), umbilical cord blood, or Wharton’s jelly (umbilical cord tissue). Most people have adequate amounts of fat just under the skin, and umbilical cord blood and tissue are thrown away as medical waste every day.
Fortunately for patients, Dr. Yoo and colleagues showed that mesenchymal stem cells taken from fat tissue, umbilical cord blood, and Wharton’s jelly exhibit the same immunomodulatory properties as mesenchymal stem cells taken from bone marrow. The researchers showed that these types of mesenchymal stem cells were able to suppress T-cell proliferation as effectively as those cells taken from bone marrow. T-cell proliferation, it should be pointed out, is a key step in autoimmune inflammation that occurs in diseases such as rheumatoid arthritis and others.
In short, mesenchymal stem cells taken from easier-to-get tissues were just as effective at suppressing inflammation (in vitro) as those taken from bone marrow. These results will need to be confirmed in clinical studies; however, this approach will be much more convenient and less expensive for patients and donors if they can use mesenchymal stem cells taken from fat or umbilical cord rather than bone marrow and yet reap the same benefits.
Reference: Yoo KH et al. (2009). Comparison of immunomodulatory properties of mesenchymal stem cells derived from adult human tissues. Cell Immunology. 2009;259(2):150-6.
Certain types of food are commonly known to trigger inflammation in people who are sensitive to specific agents. To manage diseases such as irritable bowel syndrome, Crohn’s disease, and other chronic inflammatory disorders, many people have turned to the low-FODMAP diet.
What Does FODMAP Mean?
FODMAP is an acronym for fermentable oligo-, di-, monosaccharides and polyols. In short, they are dietary sugars found in many grains, types of produce, and dairy products. While these FODMAPs sound complex, they simply refer to characteristics in foods that are known to present digestion challenges. These agents are highly fermentable, and it is their rapid fermentation that leads to bowel issues. For instance, they create an osmotic effect, meaning they draw water through the bowel, creating increased permeability. They are also poorly absorbed within the small intestine, and the fermentation that takes place within can create gas, abdominal pain, discomfort, diarrhea, and constipation.
Which Foods are Considered High-FODMAP?
There are many foods high in FODMAPs. Foods with excess fructose, including honey, dried fruit, watermelon, pears, and apples, should be avoided on the diet. Sources of lactose, including milk, yogurt, and dairy desserts, are also high-FODMAP. Leeks, onions, barley, rye, wheat, garlic, legumes, cashews, and chickpeas are best avoided on the diet as well. This list is by no means exhaustive, however, and there are many other foods considered to be high enough in FODMAPs to cause an inflammatory response. With that said, certain food sources don’t have to be avoided entirely on the diet and limiting portion sizes may be enough to minimize inflammatory effects.
Is the Low-FODMAP Diet Right for Me?
Because many high-FODMAP foods are also rich sources of key nutrients, it is typically not recommended for anyone who doesn’t have an apparent sensitivity to FODMAPs to try the diet. Avoidance of FODMAPs could put individuals at risk of nutritional deficiencies, as it restricts many healthy foods. Thus, it should only be followed as prescribed by healthcare professionals.
In fact, this restrictive diet is only practiced for three to eight weeks at a time. It is typically followed in phases. The first phase involves strict elimination of FODMAPs, followed by a reintroduction stage during which one type of FODMAP is introduced at a time. This allows patients to gauge which group triggers the most significant inflammatory response. Then, in the final phase, the modified FODMAP diet can be followed, in which certain trigger foods can be avoided at the patient’s discretion.
While a low FODMAP diet is not intended to be a permanent solution, it can shed light on which dietary sources elicit the most challenging symptoms in disorders like IBS and Crohn’s disease. If you’re interested in exploring the eating plan to help you manage your condition, be sure to speak with your gastroenterologist to discuss your eligibility for the diet.
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