Sunday, May 26, 2013

Crohn's, Ulcerative Colitis, and Ayurveda


Ayurvedic “Medicine” and IBD


Ayurveda is a form of alternative medicine in India (the term refers to medicine in general, but it has come to be associated with a particular form in Western parlance).  Ayurveda’s principles were established around the transition from BCE to CE, and include many of the same concepts that were popular in early Greek medicine – the concept of three humors, or fluids, present in the body (linked to the elements fire, earth, water, and air) and the concept of “channels” present in the body that need to be aligned. 

While knowledge of basic anatomy grew in other parts of Eurasia and North Africa, showing how the body functioned through dissection and observation, the Ayurvedic system continued in India through to the present.  While India has some of the world’s foremost physicians, they are differentiated from Ayurvedic practitioners by training and the application of evidence to their techniques.

Ayurveda’s treatment modalities are broken along 8 paths.  The two most prominent modalities, hygiene and herbal medicine, are the most well-known.  Other paths include surgical, diet, and meditation-based healing.(1)

The key Ayurvedic medicine associated with IBD is Boswellia serrate, more commonly known as frankincense.  Given in oral dosing, Boswellia has been shown to have a similar efficacy to 5-ASA drugs in maintaining remission in early studies, but the comparison to placebo in a recent double blind study showed no increased efficacy.  Overall, the safety profile of Boswellia is good, but it does not appear to have a clinically significant effect.(2)

Turmeric (Curcumin) has also been postulated as a treatment for IBD.  A common cooking ingredient, Curcumin showed efficacy as an anti-inflammatory in induced colitis in mouse studies.(3)  To date, there have been two human studies using curcumin to treat IBD.  Both were open-label pilots, though, and the subjects remained on existing medications.  Because there were no controls or blinding (and the studies were small), there isn’t really data to support its medicinal use to treat Crohn’s and IBD, though better double blind studies are a possibility.  That said, it is a tasty edition to many Southeast Asian dishes, and makes a nice addition to curry!(4)

Unfortunately, even if the Curcumin studies show positive results, it would not be recommended that patients purchase them from ayurvedic suppliers.  Not controlled or monitored as drugs, ayuverdic medicines have shown toxic levels of lead, arsenic, and other heavy metals when properly assayed.(5)

Ayurvedic medicine does not have a solid theoretical basis, but there are some practitioners that have proposed the discipline adopt a true evidence-based approach.  If these proponents have their way, we may see true evidence to support (or refute) the ayurvedic approaches.  If the treatments turn out to have a positive effect and quality control can be ensured, there is some promise in ayurvedic treatments, especially the herbal possibilities.(6) 

Bottom Line


·         Ayurveda’s theoretical basis is founded on long disproven theories of body function.
·         Some of the modalities (such as practicing good hygiene) are not unique to ayuverda and are general good life skills.
·         Other modalities (the herbal supplements) are unregulated and dangerous.
·         Current studies have failed to show efficacy of ayurvedic techniques to treat IBD, but turmeric is a low risk possibility as an anti-inflammatory and warrants further investigation.

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1.       Patwardhan, Bhushan, Dnyaneshwar Warude, P. Pushpangadan, and Narendra Bhatt. "Ayurveda and traditional Chinese medicine: a comparative overview."Evidence-Based Complementary and Alternative Medicine 2, no. 4 (2005): 465-473.
2.       Holtmeier, Wolfgang, Stefan Zeuzem, Jan Preiβ, Wolfgang Kruis, Stephan Böhm, Christian Maaser, Andreas Raedler et al. "Randomized, placebocontrolled, doubleblind trial of Boswellia serrata in maintaining remission of Crohn's disease: Good safety profile but lack of efficacy." Inflammatory bowel diseases 17, no. 2 (2011): 573-582.
3.       Sugimoto, Ken, Hiroyuki Hanai, Kotaro Tozawa, Taiki Aoshi, Masato Uchijima, Toshi Nagata, and Yukio Koide. "Curcumin prevents and ameliorates trinitrobenzene sulfonic acid–induced colitis in mice." Gastroenterology 123, no. 6 (2002): 1912-1922.
4.       Taylor, Rebecca A., and Mandy C. Leonard. "Curcumin for inflammatory bowel disease: a review of human studies." Alternative medicine review: a journal of clinical therapeutic 16, no. 2 (2011): 152.
5.       Saper, Robert B., Russell S. Phillips, Anusha Sehgal, Nadia Khouri, Roger B. Davis, Janet Paquin, Venkatesh Thuppil, and Stefanos N. Kales. "Lead, mercury, and arsenic in US-and Indian-manufactured Ayurvedic medicines sold via the Internet." JAMA: the journal of the American Medical Association 300, no. 8 (2008): 915-923.
6.       Singh, Ram Harsh. "Exploring larger evidence-base for contemporary Ayurveda." International Journal of Ayurveda Research 1, no. 2 (2010): 65.

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