Ulcerative Colitis

By Raksha Pradhan, Candidate for Doctor of Osteopathic Medicine 2016 and Dr. Courtney Mizuhara-Cheng, D.O., M.S.H.S.

Have you had issues with frequent diarrhea?  Do you feel like your going to the bathroom a lot more often than normal?  Do you have recurrent stomach cramps?  Is there blood in your stool?  All of these are very important questions to consider if you think you have an inflammatory bowel disease called Ulcerative Colitis.

What is Ulcerative Colitis?

Ulcerative colitis is a disease that causes inflammation of the large intestine, which is also called the colon.  To simply break down the name of the disease, “ulcerative” means that the disease creates ulcers and “colitis” means inflammation of the colon.  The inflammation of the lining of the colon can eventually develop into ulcers.  These ulcers can flare up (just like a stomach ulcer) which causes the diarrhea that may contain blood.  The source of the blood is from the bleeding ulcers.  Ulcerative colitis is typically a long-term issue.  The disease develops over time.  The first sign may just be an increase in number of bowel movements each day.  This can be accompanied with “crampy” abdominal pain.  While an occasional episode of diarrhea is not too concerning, multiple episodes of diarrhea accompanied with blood definitely is a big concern.  Blood in the stool should prompt you to visit your doctor right away.  Other symptoms that are important to recognize are fever, shortness of breath, a sensation that the heart is racing, loss of appetite, and unintentional weight loss.  While ulcerative colitis is a chronic disease, it is definitely manageable.  There are a group of medications that help to reduce the inflammation of the colon and prevent the development of ulcers. It is important that you collaborate early with your doctor and understand the importance of treatment.

CONNECT WITH YOUR COLON

The colon is the last part of the digestive tract.  The primary responsibility of the colon is to reabsorb water and nutrients.  When the colon becomes inflamed, it becomes more difficult for the colon to reabsorb things.

What is the treatment?

The main goal of treatment is to reduce the inflammation of the colon.  This can be done with a variety of medications that includes steroids and antibiotics.  Antibiotics are needed when there is an infection in the colon.  There are also medications that can reduce the occurrence of ulcers. Depending on the extent of inflammation, surgery may be indicated.  However, your doctor will be able to better determine this after taking a thorough history.

What can you expect when you visit your doctor?

If you are experiencing symptoms that may be suggestive of ulcerative colitis, your doctor will want to get a detailed history.  The doctor will want to know about the timing of the symptoms and if there is anything that triggers the symptoms such as foods, allergies, stress, etc.  The doctor may ask you to describe the pain and to show the location of the pain.  While it may be uncomfortable or embarrassing to discuss, your doctor may also ask you to describe your stool.  This is especially important to discuss if you have blood in your stool.  These types of questions will help the doctor to arrive at the correct diagnosis.

What tests can be expected?

You can also expect to have some laboratory tests.  This will help the doctor to determine if there are any other clues to the diagnosis.  It is common with persons experiencing frequent diarrhea to have abnormal lab test results.  Your doctor may also want to collect a stool sample to make sure there is no infection of your colon with bacteria or parasites.  It is not uncommon for doctors to order imaging tests to get a better look at what is going on inside the abdomen.   If you are 50 years or older, it is recommended that you have a colonoscopy to screen for colon cancer.  Ulcerative colitis is considered a risk factor for the development of colon cancer.  Therefore, it is important to begin treatment early and to follow up with your doctor regularly.

HARMONIZE WITH YOUR COLON

How does nutrition influence the Ulcerative Colitis?

Due to the loss of appetite caused by UC, many individuals may not get the nutrition and calories needed to meet the body's energy demands.  In addition, persistent diarrhea that often results from UC can cause the malabsorption of important nutrients such as carbohydrates, fats, proteins, vitamins, minerals and most importantly water. As a result, proper nutrition plays an important role in management of UC.

Some recommended dietary modifications include:

• Eat smaller meals more often.  This allows the colon to become more stabilized and less irritable. 
• Drink plenty of liquids.  Maintaining a good hydration status is key to good health and overall well-being.  
• Take multivitamin supplements.  Since the colon is irritated, it is more difficult to reabsorb nutrients compared to a normal, healthy colon.   to meet all the nutritional requirements.  

Ulcerative colitis is not caused by any particular foods, but certain foods can trigger a flare-up and cause further inflammation and irritation to the colon.   There are a select group of foods that is best to limit or avoid.

• Dairy products, especially for those that are lactose intolerant.
• High-fat foods, these can make your diarrhea worse
• High-fiber foods 
• Spicy foods
• Alcohol
• Caffeine

What Lifestyle Modifications can help?

Stress Reduction.  Although stress is not considered a cause of ulcerative colitis, it can trigger the inflammation so it is important to manage stress levels.
Increase Exercise.  Studies have shown that exercise is an excellent stress reducing activity that can also help relieve depression.  Research has also found that exercise can help normalize bowel function and promote regularity in bowel movements.
Start relaxation exercises and breathing techniques.  Popular relaxation exercises that incorporate breathing techniques include yoga, pilates, and meditation.

INTEGRATE COMPLIMENTARY ALTERNATIVE METHODS

What to expect from your Osteopathic physician?

It is important when treating any disease to consider the body as one single harmonious unit.  While the problem may be localized to the colon, it is important to look beyond that part of the body.  The colon is a large organ that has an intricate involvement of nerves and muscle.  The same nerves that supply information to the colon can be localized to a source along the spinal cord.  As osteopathic physicians, we use the vertebral column as anatomic landmarks for these nerves.  The nerves that innervate the colon originate from the thoracic vertebrae and extend downwards to the lumbar vertebrae.  Having this knowledge helps physicians to provide alternative treatment options to reduce the pain and discomfort caused by ulcerative colitis.

What other alternative remedies are available?

As with many other medical conditions, there are popular alternative remedies for ulcerative colitis. The fennel seed is a popular spice used in Southeast Asian cuisine.  It not only provides a vibrant flavor to foods, but it also is a great digestive aid.  The oils released from the seed stimulates the lining of the digestive tract, promoting better motility of the small and large intestines.  Improved motility means that nutrients can be easily absorbed and stool can pass through the colon more efficiently.  The fennel seed oil also reduces the spastic reaction the colon has to the inflammation. Decreased spasticity of the colon reduces the stomach cramps, bloating, gas, and diarrhea.

Are there any dangers of eating fennel seeds?

The fennel seed is considered to be gentle and safe.  However, like any other foods, there is a risk of allergic reaction.  Make sure to discuss your allergy history with your doctor before deciding to try this home remedy.  Also, keep in mind that everything should be taken in moderation.  Too much of the fennel seed oil can become toxic.  For ulcerative colitis, it is recommended to use the whole fennel seed rather than the essential fennel seed oil.  Do not consume fennel seeds if you are pregnant.

Simple Recipe for Fennel Seed Tea

• 1-2 teaspoons of whole fennel seeds
• 1 cup boiling water

Instructions

1. Crush the whole fennel seeds to release the oil.
2. Use 1-2 teaspoons of crushed seeds for 1 cup of boiling water
3. Add the crushed seeds to the boiling water and allow to brew for 5-10 minutes (the longer you brew the tea, the stronger the flavor)
4. Strain the seeds and serve hot
5. Enjoy the tea!

Other Resources

• http://www.ccfa.org/what-are-crohns-and-colitis/what-is-ulcerative-colitis
• http://programs.rmei.com/knowyouribdvl/Understanding_Colitis/index.html
• http://www.onegreenplanet.org/natural-health/plant-based-dietary-tips-for-those-with-ulcerative-colitis/
• http://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/basics/definition/con-20043763
• http://www.herbaleducation.net/fennel

Memory Loss

By Charlotte Zhong, Candidate for Doctor of Osteopathic Medicine 2016

Memory loss is often attributed to the natural process of aging; therefore, this symptom can be easily disregarded by many patients as a fruitless concern. However, patients and their families should be made aware of the fact that there are reversible causes of memory loss that are easy to treat. If you are experiencing memory loss, a healthcare professional can help evaluate the cause of the problem and guide you through the proper steps of management. Although mild forgetfulness is not considered an alarming symptom in adults, it is important to visit a doctor if the onset of memory loss is sudden, severe, accompanied by personality changes or focal neurological deficits such as slurred speech, weakness, etc. 

CONNECT WITH YOUR BRAIN

What are common causes of memory loss?

Medications	Many common medications can interfere with memory: antihistamines, antidepressants, anti-anxiety medications, sleeping pills, muscle relaxants, and pain medications are a few.
Alcohol, tobacco, or drug use	Excessive alcohol use has been shown to cause memory impairment in many ways. Smoking reduces the amount of oxygen that gets to the brain. Illicit drugs can cause chemical imbalances within the brain that impair its function.
Sleep deprivation	Getting too little or poor quality sleep can lead to fatigue, which interferes with the brain’s memory-encoding mechanisms.
Stress	Tension and anxiety can overstimulate or distract the mind which can impair the ability to remember.
Depression	Being depressed can make it difficult to pay attention and concentrate. Pseudodementia is a term used to describe depression presenting as memory loss. Depression (including thoughts of suicidality, loss of interest, feelings of guilt, decrease in energy, difficulty concentrating, loss of appetite, agitation, sleep disturbance) should be brought to the attention of a doctor.
Nutritional deficiency	A balanced diet with high-quality proteins and fats help keep brain cells healthy. Lacking certain vitamins like vitamin B1, B12, and E can also affect memory.
Other	Other possible causes include: an underactive thyroid gland, infections such as HIV, tuberculosis, and syphilis, traumatic brain injury, stroke, and dementia.

HARMONIZE THE MIND & BODY & SPIRIT

How does nutrition influence memory loss?

Brain cells and nerves all throughout the body require good fats, proteins, and vitamins that help keep their signaling pathways smooth. 

A balanced diet includes:

Healthy fats	olive oil, nuts (almonds, cashews, pecans), avocados, fish (salmon, tuna)
Vitamin B1 (thiamine)	Common dietary sources include cereal grains, oatmeal, brown rice
Vitamin B12	found in most animal derived foods such as meat, poultry, eggs, and milk
Vitamin E	olive oil, nuts, dark green leafy vegetables
Water	Dehydration causes brain fog, irritability, fatigue, and various other symptoms. Keeping hydrated is essential for optimal delivery of nutrients to the brain and for removing toxins.

What lifestyle modifications can help
Know your own body’s reaction to medications. Let your doctor know if you are experiencing any side effects to medications. Consider collaborating with your physician on alternative methods of treatment rather than continuing medications with unfavorable effects. 
Consider decreasing or stopping alcohol, tobacco, and drug use.  These chemicals are harmful to the brain. Let your doctor know if you are interested in quitting and to learn more about resources are available to you.
Find healthy ways to deal with stress.  Find time to partake in activities that relax you. This differs for everyone; it can include yoga, meditation, drawing, singing, boxing, cooking, cleaning, and more.  Studies have shown that the endorphins released during exercise are a potent stress reducer which can also help alleviate symptoms of depression. 
Exercise good sleep hygiene. Minimize distractors before bedtime.  Avoid watching TV or use of other electronic devices right before bed. Exercising late at night can also be counterproductive to falling asleep. A good night’s sleep is essential for the brain to rest and recharge. 

INTEGRATING COMPLEMENTARY ALTERNATIVE METHODS

What can you expect from your osteopathic physician?

Osteopathic physicians are trained to incorporate the mind, body, and spirit when evaluating the patient as a whole. Psychological, physiological, and outside causes of memory loss will all be screened for. Osteopathic physicians can also incorporate their knowledge of neuromuscular medicine to help manually treat problems such as acute or chronic pain that would otherwise need medications. Furthermore, addressing any physical tension may relieve psychological stress and improve mood and quality of sleep. 

What other alternative remedies are available?

Taking appropriate amounts of multivitamins are encouraged by a majority of physicians if daily values are hard to meet with food alone. As with other medical conditions, there is a popular rise in the pursuit of alternative medicine. The following is a list of popular herbs used in homeopathic medicine to prevent and treat memory loss. Gingko Biloba, ginseng, rosemary, sage, and green tea all contain antioxidants to combat free radicals that contribute to health disorders like Alzheimer’s and dementia.Studies have shown that some of these herbs can also enhance memory. Blueberries are also shown to have anti-inflammatory and antioxidant properties that play vital roles in improving brain function, slowing cognitive decline, and in preventing memory loss that normally comes with aging.