An evidence-based look at Crohns Disease and Ulcerative Colitis. This blog explores various aspects of inflammatory bowel disease, including nutrition, treatment, and lifestyle based on clinical evidence.
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
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)
·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.
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.
Wolfgang, Stefan Zeuzem, Jan Preiβ, Wolfgang Kruis, Stephan Böhm, Christian
Maaser, Andreas Raedler et al. "Randomized, placebo‐controlled, double‐blind 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.
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.
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.
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.
Harsh. "Exploring larger evidence-base for contemporary Ayurveda."International Journal of Ayurveda Research 1, no. 2 (2010): 65.